Systems, devices, and methods for forming an anastomosis

ABSTRACT

Disclosed herein are systems, devices, and methods for treating heart failure. In some variations, a catheter for forming an anastomosis in a heart may comprise a first catheter comprising an electrode. A second catheter may be slidably disposed within the first catheter. The second catheter may comprise a barb and a dilator comprising a mating surface configured to engage the electrode.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation of U.S. patent application Ser. No.17/019,042, filed Sep. 11, 2020, which claims the benefit of U.S.Provisional Application No. 62/971,357, filed Feb. 7, 2020, and U.S.Provisional Application No. 62/900,034, filed Sep. 13, 2019, the contentof each of which is hereby incorporated by reference in its entirety.

TECHNICAL FIELD

Devices, systems, and methods herein relate to forming an anastomosis,including but not limited to an anastomosis in a heart of a patient.

BACKGROUND

Congestive heart failure (CHF) is marked by declining function of theheart muscle, either due to a weakening of its pumping ability or astiffening of the muscle with decreased ability to fill with blood priorto ejection. With poor flow of blood from the heart to vital organs, therenin-angiotensin-aldosterone system (RAAS) is activated, which signalsthe body to retain fluid, thereby increasing pressure in the heartchambers. In particular, as the left atrial pressure (LAP) rises, fluidbacks up into the pulmonary circulation and may lead to pulmonary edemaand severe shortness of breath. As such, additional devices, systems,and methods for treating heart failure may be desirable.

SUMMARY

Described herein are devices, systems, and methods for treating heartfailure. These devices and systems may form an anastomosis in ananatomical structure. In some variations, a catheter for forming ananastomosis in a heart may comprise a first catheter comprising anelectrode. A second catheter may be slidably disposed within the firstcatheter. The second catheter may comprise a barb and a dilatorcomprising a mating surface configured to engage the electrode.

In some variations, the barb may be disposed within a lumen of theelectrode when the mating surface engages the electrode. In somevariations, an outer diameter of the dilator may be less than an outerdiameter of the electrode. In some variations, the barb may beconfigured to engage tissue.

In some variations, the second catheter may define a longitudinal axis.The barb may comprise at least one projection comprising a first portionand a second portion. The first portion may be angled relative to thesecond portion. A length of the first portion to a length of the secondportion may be in a ratio between about 2:3 and about 1:5. In somevariations, the second portion may comprise a length between about 0.1mm and about 2 cm. The first portion may be angled between about 60degrees and about 120 degrees relative to the longitudinal axis. In somevariations, the first portion may be substantially perpendicular to thelongitudinal axis. In some variations, the second portion may be angledup to about 30 degrees relative to the longitudinal axis. In somevariations, the second portion may be substantially parallel to thelongitudinal axis. In some variations, the barb may comprise betweenabout 3 projections and about 7 projections. In some variations, atleast one projection may comprise one of an “L” shape, “J” shape, and“C” shape. In some variations, at least one projection may comprise aplurality of projections configured in a set of concentric rings. Insome variations, at least one projection may be configured to penetratethrough tissue.

In some variations, the barb may comprise one or more projections angledbetween about 5 degrees and about 60 degrees relative to thelongitudinal axis. In some of these variations, the one or moreprojections may be configured in rows along a length of the barb. Insome variations, the projections may be configured to penetrate throughthe tissue and reduce tissue shear. In some variations, a length of thebarb may be between about 0.1 mm and about 5 cm. In some variations, theelectrode and the mating surface may be configured to compress tissuetherebetween. In some variations, the second catheter may define alongitudinal axis, and the mating surface may be non-perpendicular andnon-parallel to the longitudinal axis.

In some variations, the first catheter may comprise an insulatordisposed over a portion of the electrode. In some variations, theinsulator may comprise a fluoropolymer material. In some variations, adistal surface of the electrode and at least a portion of an innerdiameter of the electrode may be uninsulated. In some variations, theelectrode may be proximal to the dilator. In some variations, the firstcatheter may define a vent lumen. In some variations, a signal generatormay be configured to generate a biphasic waveform, and the signalgenerator may be coupled to the electrode.

In some variations, the barb may define a longitudinal axis, and thebarb may be configured to rotate about the longitudinal axis. In somevariations, the barb may be configured to rotate up to about 360 degreesabout the longitudinal axis.

In some variations, the dilator may define a recess configured to holdthe barb. In some variations, the barb may be arranged inside the recessin a first configuration and at least a portion of the barb may bearranged outside the recess in a second configuration. In somevariations, a length of the recess may be at least equal to a length ofthe barb. In some variations, the barb may be configured to translaterelative to the dilator to transition between the first configurationand the second configuration.

In some variations, the dilator may comprise a fluid port configured tooutput a contrast agent. In some variations, a proximal portion of thedilator may comprise the fluid port. In some variations, the fluid portmay be configured to receive the contrast agent from a lumen of theelectrode. In some variations, the first catheter may comprise acontrast agent lumen. In some variations, the first catheter may beconfigured to output a contrast agent. In some variations, the contrastagent may be output into a lumen of the electrode. In some variations,the electrode may comprise a fluid port configured to output a contrastagent. In some variations, a distal end of the electrode may comprisethe fluid port.

In some variations, the dilator may comprise an echogenic region. Insome variations, the echogenic region may comprise one or more recessesor protrusions. In some variations, the one or more recesses orprotrusions may comprise a diameter of between about 5 μm and about 100μm. In some variations, the echogenic region may comprise a recess andprotrusion density of between about 5% and about 50%. In somevariations, the dilator may comprise one or more microspheres. In somevariations, the one or more microspheres may comprise a gas core. Insome variations, the one or more microspheres may comprise glass. Insome variations, the echogenic region may be on a surface of thedilator. In some variations, the echogenic region may be below a surfaceof the dilator.

In some variations, a first catheter actuator may be configured todeflect a distal portion of the first catheter, the first catheteractuator electrically coupled to the electrode. In some variations, aproximal end of the first catheter actuator may be configured to coupleto an actuation mechanism. In some variations, the first catheteractuator may comprise a pull wire extending along a length of the firstcatheter. In some variations, the distal portion of the first cathetermay comprise a predetermined bend. In some variations, the predeterminedbend may comprise an angle between about 30 degrees and about 70degrees.

In some variations, the mating surface may define a recess configured toreceive a distal end of the electrode. In some variations, the electrodemay be configured to electrically short when the electrode engages therecess of the mating surface. In some variations, the mating surface maycomprise a deformable material. In some variations, the mating surfacemay comprise a non-conductive portion. In some variations, thenon-conductive portion may comprise one or more of a polymer, ceramic,and aluminum oxide. In some variations, the mating surface may comprisea conductive portion.

In some variations, a proximal portion of the dilator may be arrangedwithin a lumen of the electrode when the mating surface engages theelectrode. In some variations, between about 0.5 mm and about 2 mm ofthe proximal portion of the dilator may be disposed within the lumen ofthe electrode when the mating surface engages the electrode.

In some variations, a signal generator may be configured to generate afirst waveform followed by a second waveform. The signal generator maybe coupled to the electrode. The first waveform may comprise a firstvoltage and the second waveform may comprise a second voltage. The firstvoltage may be higher than the second voltage.

Also described here are methods. In some variations, a method of formingan anastomosis in a heart may comprise advancing a first and secondcatheter into a right atrium. The first catheter may comprise a tubularelectrode defining a lumen and the second catheter may comprise adilator and a barb. The second catheter may be advanced into a leftatrium through an interatrial septum such that the first catheter is inthe right atrium. The second catheter may be withdrawn relative to thefirst catheter to engage a first portion of the septum to the barb,withdraw the first portion into the lumen, and compress a second portionof the septum between the electrode and the dilator. An ablationwaveform may be delivered to the electrode to cut the second portionsuch that the first portion is held within the lumen.

In some variations, withdrawing the second catheter towards the firstcatheter may comprise withdrawing the barb into the lumen. In some ofthese variations, a size of the first portion cut from the secondportion may correspond to a distance the barb is withdrawn into thelumen. In some variations, withdrawing the second catheter towards thefirst catheter may stretch the first portion. In some variations, thefirst portion may form a substantially conical or cylindrical shape whenengaged by the barb.

In some variations, the first portion of the septum may form asubstantially cylindrical shape when withdrawn into the lumen. In somevariations, the first portion of the septum engaged to the barb may beintact when withdrawn into the lumen. In some variations, the barb maypierce through the first portion when withdrawing the second cathetertowards the first catheter. In some variations, an anastomosiscomprising a diameter between about 1 mm and about 1.5 cm may be formedin response to delivering the ablation waveform. In some variations, thefirst portion may form a substantially conical shape when engaged by thebarb. In some variations, the first portion may be engaged by the barbat least during delivery of the ablation waveform. In some variations,the first portion may be engaged by the barb after delivering theablation waveform to the electrode.

In some variations, the second portion may be compressed with a force ofat least 20 grams. In some variations, at least a portion of the barbmay penetrate through the septum during engagement. In some variations,the electrode may be electrically shorted when the electrode contactsthe dilator during delivery of the ablation waveform. In somevariations, the ablation waveform may comprise a biphasic waveform. Insome variations, a radiopaque portion of one or more of the first andsecond catheters may be fluoroscopically imaged during one or moresteps.

In some variations, engaging the first portion of the septum to the barbmay comprise rotating the barb about a longitudinal axis of the barb. Insome variations, a size of the first portion cut from the second portionmay correspond to a rotation angle of the barb. In some variations,rotating the barb may comprise a rotation angle of up to about 360degrees.

In some variations, withdrawing the second catheter towards the firstcatheter may comprise translating the barb relative to the dilator toengage the first portion of the septum.

In some variations, withdrawing the second catheter towards the firstcatheter may comprise withdrawing the barb away from the dilator.

In some variations, withdrawing the second catheter towards the firstcatheter may comprise transitioning from a first configuration where thebarb is arranged inside a recess of the dilator to a secondconfiguration where the barb is arranged outside the recess.

In some variations, a contrast agent may be introduced into the heartvia a fluid port in the dilator. In some variations, a contrast agentmay be introduced into a lumen of the electrode. In some variations,ultrasound waves may be received from a distal end of the ablationdevice. In some variations, the distal end of the ablation device maycomprise one or more microspheres comprising a diameter of between about5 μm and about 100 μm.

In some variations, withdrawing the second catheter towards the firstcatheter may deform a proximal portion of the dilator. In somevariations, withdrawing the second catheter towards the first cathetermay comprise engaging the electrode to a mating surface of the secondcatheter. In some variations, compressing the second portion of theseptum may comprise a distal end of the electrode and a mating surfaceof the dilator. In some variations, the second portion may be compressedwith a force of up to about 25 N.

In some variations, an ablation waveform may comprise a first waveformfollowed by a second waveform. The first waveform may comprise a firstvoltage and the second waveform may comprise a second voltage. The firstvoltage may be higher than the second voltage.

In some variations, a proximal portion of the dilator may comprise afirst step portion comprising a first diameter and a second step portioncomprising a second diameter greater than the first diameter. The firststep portion may be proximal to the second step portion. In somevariations, the second step may comprise the mating surface configuredto engage a distal end of the electrode. In some variations, the matingsurface may be substantially perpendicular to a longitudinal axis of thedilator. In some variations, the first step may be configured to engagea sidewall of the electrode when the dilator engages the electrode. Insome variations, the dilator may be configured to attach to the firstcatheter when the dilator engages the electrode.

In some variations, a system for forming an anastomosis in a heart maycomprise a first catheter comprising an electrode, and a second catheterslidably disposed within the first catheter. The second catheter maycomprise a barb and a dilator. A proximal portion of the dilator maycomprise a first step portion comprising a first diameter and a secondstep portion comprising a second diameter greater than the firstdiameter. The first step portion may be proximal to the second stepportion.

In some variations, a system for forming an anastomosis in a heart maycomprise a first catheter comprising an electrode, and a second catheterslidably disposed within the first catheter. The second catheter maycomprise a barb and a dilator. The barb may be enclosed within a lumenof the electrode when the dilator engages the electrode.

In some variations, a system for forming an anastomosis in a heart maycomprise a first catheter comprising an electrode, and a second catheterslidably disposed within the first catheter. The second catheter maycomprise a barb and a dilator. The system may be configured to compresstissue between the electrode and the dilator with a first predeterminedforce.

In some variations, the dilator may be configured to shear the tissuewith a second predetermined force greater than the first predeterminedforce. In some variations, the first predetermined force may be up toabout 25 N. In some variations, the second predetermined force may bemore than about 25 N.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 provides a cross-sectional representation of a heart showingvarious anatomical structures.

FIGS. 2A-2F are schematic perspective views of an illustrative variationof a method of forming an anastomosis using an ablation system.

FIG. 3 is a schematic block diagram of an illustrative variation of anablation system.

FIG. 4 is a perspective view of an illustrative variation of an ablationdevice.

FIG. 5A is a schematic cross-sectional side view of an illustrativevariation of an ablation device in an open configuration. FIG. 5B is aschematic cross-sectional side view of an illustrative variation of anablation device in a closed configuration.

FIG. 6A is a schematic side view of an illustrative variation of anablation device in a closed configuration. FIG. 6B is a schematiccross-sectional side view of the ablation device shown in FIG. 6A. FIG.6C is a detailed cross-sectional side view of the ablation device shownin FIG. 6B.

FIG. 7A is a schematic side view of an illustrative variation of anablation device in an open configuration. FIG. 7B is a schematiccross-sectional side view of the ablation device shown in FIG. 7A. FIG.7C is a detailed cross-sectional side view of the ablation device shownin FIG. 7B.

FIG. 8 is a schematic perspective view of an illustrative variation ofan ablation device.

FIG. 9A is a schematic side view of an illustrative variation of anablation device in a closed configuration. FIG. 9B is a schematiccross-sectional side view of an illustrative variation of an ablationdevice in a closed configuration.

FIG. 10A is a schematic side view of an illustrative variation of anablation device in an open configuration. FIG. 10B is a schematiccross-sectional side view of an illustrative variation of an ablationdevice in an open configuration.

FIG. 11A is a schematic cross-sectional side view of an illustrativevariation of an electrode of an ablation device. FIG. 11B is a detailedcross-sectional side view of a distal end of the electrode shown in FIG.11A.

FIG. 12A is a schematic perspective view of an illustrative variation ofa connector of an ablation device. FIG. 12B is a schematic front view ofan illustrative variation of a connector of an ablation device. FIG. 12Cis a schematic cross-sectional side view of an illustrative variation ofa connector of an ablation device.

FIG. 13A is a schematic perspective view of an illustrative variation ofa barb of an ablation device. FIG. 13B is a schematic side view of anillustrative variation of a barb of an ablation device. FIG. 13C is aschematic front view of an illustrative variation of a barb of anablation device.

FIG. 14 is a schematic side view of an illustrative variation of a barbof an ablation device.

FIG. 15A is a schematic perspective view of an illustrative variation ofa barb of an ablation device. FIG. 15B is a schematic front view of anillustrative variation of a barb of an ablation device.

FIG. 16 is a schematic side view of an illustrative variation of a barbof an ablation device.

FIGS. 17A and 17B are schematic side and perspective views of anillustrative variation of a barb of an ablation device.

FIG. 18 is a flowchart of an illustrative variation of a method offorming an anastomosis.

FIGS. 19A and 19B are schematic perspective views of an illustrativevariation of an ablation device in an endocardial space. FIGS. 19C-19Fare schematic cross-sectional side views of illustrative variations ofan ablation device in an endocardial space.

FIG. 20 is a perspective view of an illustrative variation of anablation device.

FIG. 21 is a perspective view of an illustrative variation of anablation device.

FIG. 22 is perspective view of an illustrative variation of an ablationdevice engaged to cut tissue.

FIG. 23 is a fluoroscopic visualization of illustrative variations ofthe ablation device in open and closed configurations.

FIG. 24 is an image of an anastomosis formed in cadaver tissue.

FIGS. 25A and 25B are images of an anastomosis formed in porcine tissue.

FIG. 26A is a schematic side view of an illustrative variation of a barbof an ablation device. FIG. 26B is a schematic perspective view of anillustrative variation of a barb of an ablation device. FIG. 26C is aschematic front view of an illustrative variation of a barb of anablation device.

FIGS. 27A and 27B are perspective views of an illustrative variation ofan ablation device engaged to cut tissue. FIG. 27C is an image of ananastomosis formed in tissue.

FIGS. 28A and 28B are perspective views of an illustrative variation ofan ablation device engaged to cut tissue.

FIGS. 29A, 29B, and 29C are side views of a barb of an ablation devicein an endocardial space.

FIGS. 30A and 30B are cross-sectional side views of a barb and catheterof an ablation device.

FIG. 31A is a side view of an illustrative variation of an ablationdevice. FIG. 31B is a cross-sectional side view of an illustrativevariation of an ablation device. FIG. 31C is a detailed cross-sectionalside view of the ablation device shown in FIG. 31B. FIGS. 31D, 31E, and31F are perspective views of illustrative variations of a distal portionof an ablation device.

FIG. 32 is a side view of an illustrative variation of an ablationdevice in an endocardial space.

FIG. 33A is a side view of an illustrative variation of a catheter of anablation device. FIG. 33B is a cross-sectional side view of anillustrative variation of a catheter of an ablation device.

FIGS. 34A and 34B are cross-sectional plan views of a distal end of acatheter of an ablation device. FIGS. 34C and 34D are cross-sectionalside views of a catheter of an ablation device.

FIG. 35A is a cross-sectional side view of an illustrative variation ofa distal portion of an ablation device. FIG. 35B is a detailedcross-sectional side view of another variation of a distal portion of anablation device.

FIGS. 36A and 36B are side views of an illustrative variation of anablation device in an endocardial space.

FIG. 37 is an illustrative variation of a voltage waveform of anablation procedure.

FIGS. 38A and 38B are cross-sectional side views of an illustrativevariation of an ablation device in open and closed configurations.

FIG. 39A is a perspective view of an illustrative variation of a handleof an ablation device. FIG. 39B is a plan view of the handle depicted inFIG. 39A.

FIG. 40A is a side view of an illustrative variation of a barb of anablation device. FIG. 40B is a perspective view of an illustrativevariation of a barb of an ablation device.

FIGS. 41A and 41B are schematic side and perspective views of anillustrative variation of a barb of an ablation device.

FIGS. 42A and 42B are schematic side and perspective views of anillustrative variation of an electrode of an ablation device.

DETAILED DESCRIPTION

Described here are devices, systems, and methods for treating heartfailure (e.g., congestive heart failure) by reducing blood pressure in aleft atrium of a patient. For example, an anastomosis between a rightatrium and a left atrium may be formed to relieve elevated left atrialblood pressure using an energy-based tissue ablation system. Generally,the systems described here may, for example, dispose portions of adevice on opposite sides of an interatrial septum. A portion of theseptum may be engaged to the device using a barb. In some variations, aportion of the barb may penetrate through the septum such that the barbmay securely hold an intact portion of the septum tissue. The engagedtissue may be stretched, secured, and withdrawn into a lumen of thedevice. In some variations, a size (e.g., diameter) of the tissue to becut may be controlled by varying a distance that the engaged tissue iswithdrawn into the lumen. Another portion of the septum may becompressed between an electrode and a proximal end of a dilator tosecure additional portions of the septum to the device. The electrodemay use radiofrequency (RF) energy to ablate tissue to form ananastomosis in the interatrial septum. After ablation, the electrode maycontact the dilator such that the portion of tissue engaged, held,and/or secured by the barb remains enclosed within the lumen of thedevice for removal from the patient. One or more steps of a treatmentprocedure may be visualized using one or more visualization techniquesand visualization features incorporated within the ablation device.Accordingly, the first and second catheters as described herein mayimprove the efficacy and safety of an anastomosis formation procedure,as well as allow a size of the catheter to be reduced.

In instances where the heart is the relevant anatomy, it may be helpfulto briefly identify and describe the relevant heart anatomy. FIG. 1 is across-sectional view of the heart (100). Shown there is the left atrium(110), right atrium (120), and interatrial septum (130). FIG. 1illustrates an opening (132) (e.g., aperture) formed between the leftatrium (110) and the right atrium (120). For example, the opening (132)may be created during an anastomosis procedure using the systems,devices, and methods described herein. The opening (132) may havepredetermined characteristics configured to treat heart failure.

Also described here are methods. In some variations, a method of formingan anastomosis in an interatrial septum may include the step shown inFIG. 2A including advancing an ablation device (200) into a right atrium(230) of a patient. A distal end of the device (200) may comprise adilator of a second catheter (250) configured to puncture an interatrialseptum (210) and advance into a left atrium (220) of the patient. Insome variations, a guidewire (not shown) of the device (200) may beadvanced across the interatrial septum (210) and into the left atrium(220). As shown in FIG. 2B, the dilator may puncture the septum (210)such that portions of the second catheter (250) are disposed within theleft atrium (220) and the first catheter (240) is disposed within theright atrium (230).

FIG. 2C illustrates the second catheter (250) advanced relative to thefirst catheter (240) such that a barb (260) of the second catheter (250)is advanced across the septum (210) and into the left atrium (220). Thebarb (260) may be configured to engage a portion of the septum (210) forablation. For example, a portion of the engaged septum may be heldand/or secured between the projections of the barb (260). By positioningthe device (200) across both sides of the interatrial septum (210), apredetermined force may be applied from respective catheters (240, 250)to engage and cut a predetermined portion of septum tissue.

As shown in FIG. 2D, the second catheter (250) may be withdrawn relativeto the first catheter (240) such that a portion (212) of the septum(210) may engage the barb (260) and stretch. Each of the electrode (242)(FIG. 2A) and the barb (260) may be positioned to engage opposite sidesof the septum tissue (212). For example, withdrawal of the barb (260)into a lumen of the electrode (242) may engage and stretch the tissue(212) so as to form a tent-like shape that may aid formation of ananastomosis. Tissue (212) in FIG. 2D is shown tented towards the rightatrium (230). In this manner, tissue (212) to be cut is secured withinthe device (200) prior to excision to reduce the risk of uncontrolledtissue loss in the heart chambers and vasculature.

In some of these variations, the electrode (242) may comprise a tubularshape configured to cut tissue using RF energy and promote tissuecapture. In some variations, a mating surface of the dilator (252) maybe configured to engage, hold, and secure cut tissue against a cuttingsurface of the electrode (242). An ablation waveform may be delivered tothe electrode (242) to cut the portion (212) of the interatrial septum(210) stretched by the device (200). For example, the ablation waveformmay comprise RF energy as described in more detail herein. The secondcatheter (250) may be positioned against the first catheter (240) as theelectrode (242) is energized such that the barb (260) is held in a lumenof the electrode (242).

Once the septum (210) is cut, as shown in FIG. 2E, a hole (214) may beformed in the septum (210). The second catheter (250) may be withdrawnfrom the left atrium (220) and the device (210) may be removed from thepatient as shown in FIG. 2F. Accordingly, an ablation device (200) mayform an interatrial anastomosis. The ablation devices as describedherein may improve the efficacy and safety of an anastomosis procedure,as well as allow a reduction in a size of the device. For example, aftercrossing the interatrial septum (210), the operator may capture andsecure tissue by advancing and retracting the second catheter (250)relative to the first catheter (240) without additional actuationmechanisms. This and other benefits of the devices and methods aredescribed in more detail below herein.

I. System

Overview

Systems described here may include one or more of the components used toablate tissue using the devices as described herein. FIG. 3 is a blockdiagram of a variation of an ablation system (300) comprising anablation device (310), handle (320), and signal generator (330). In somevariations, the ablation device (310) may be designed to be disposableafter each use, while in other variations, one or more portions of theablation device (310) may be designed to be reusable (e.g., usedmultiple times, and with one or more patients) such as the handle (320)and signal generator (330).

In some variations, the ablation device (310) may be comprise first andsecond catheters sized and shaped to be placed in a body cavity of thepatient such as a heart chamber. In some variations, the ablation device(310) may comprise one or more of a guidewire (312), dilator (314), barb(316), and electrode (318). A distal end of the ablation device (310)may comprise the dilator (314) and the guidewire (312) may extend from alumen of the dilator (314). In some variations, the electrode (318) maybe disposed proximal to the barb (316), while in other variations, theelectrode (318) may be disposed distal to the barb (318). Additionallyor alternatively, the ablation system (300) may comprise a deliverycatheter configured to advance over the ablation device (310).Furthermore, the ablation device (310) may comprise one or more sensorsconfigured to measure one or more predetermined characteristics such astemperature, pressure, impedance, and the like.

In some variations, a proximal end of the ablation device (310) may becoupled to a handle (320). The handle (320) may comprise an actuator(322) configured to control one or more of movement, positioning,configuration, orientation, operation, and energy delivery of theablation device (310). For example, the actuator (322) may be operatedto steer and/or translate one or more portions of the ablation device(310). In some variations, a signal generator (330) may be coupled toone or more of the ablation device (310) and handle (320). The signalgenerator (330) may be configured to generate one or more ablationwaveforms for delivery to the electrode (318) of the ablation device(310). The signal generator (330) may comprise a controller (332)configured to control the signal generator (330) and provide appropriateenergy waveforms for tissue ablation and ensure patient safety.

FIG. 4 is a perspective view of a variation of an ablation device (400).In some variations, the ablation device (400) may comprise a firstcatheter (410) and a second catheter (430). The first catheter (410) maycomprise a tubular electrode (420). The electrode (420) may define alumen (422) configured to hold one or more portions of the secondcatheter (430). The electrode (420) shown in FIG. 4 has a cylindricalshape. However, the electrode (420) may comprise any desiredcross-sectional shape (e.g., oval, square, rectangular, triangular). Theelectrode (420) shown in FIG. 4 may comprise a distal cutting edge.However, the electrode (420) may have a beveled or non-planar edge(e.g., wavy, crenelated, saw-tooth, sinusoidal, periodic, etc.).

In some variations, the ablation device (400) may comprise a secondcatheter (430) slidably disposed within the first catheter (410). Thesecond catheter (430) may comprise a barb (440) and a dilator (450)configured to engage the electrode (420). In some variations, the barb(440) may be coupled to a proximal portion of the dilator (450). Atissue engagement portion (e.g., projection, point) of the barb (440)may generally face the electrode (420). The barb (440) may comprise aplurality of projections. In some variations, one or more of theprojections may be bent to form a curvilinear shape. In some variations,a proximal portion of the dilator (450) may be configured to contact theelectrode (420) when the second catheter (430) is withdrawn relative tothe first catheter (410). The dilator (450) may have, for example, agenerally conical shape that tapers toward a distal end of the secondcatheter (430). However, the dilator (450) may comprise anypredetermined size, pattern, and shape. For example, at least a portionof the dilator (450) may be configured to recess into the lumen (422) ofthe electrode (420) to secure the dilator (450) to the catheter (410)during catheter delivery and removal and further secures excised tissueduring withdrawal from the patient.

As described in more detail herein, the second catheter (430) may beconfigured to translate relative to the first catheter (410). Forexample, the second catheter (430) may translate along a longitudinalaxis of the first catheter (410). In some variations, one or more of thesecond catheter (430), barb (440), and dilator (450) may translate intothe lumen (422) of the electrode (420). As described in more detailherein, the electrode (420) may be configured to ablate tissuecompressed between a distal end (e.g., distal cutting edge, chamfer) ofthe electrode (420) and the dilator (450).

FIG. 5A is a schematic cross-sectional side view of a variation of anablation device (500) in an open configuration. In some variations, theablation device (500) may comprise a first catheter (510) and a secondcatheter (530). The first catheter (510) may comprise a tubularelectrode (520) and a connector (526) coupled to the electrode (520).The electrode (520) may define a lumen (522) configured to hold one ormore portions of the second catheter (530). The first catheter (510) mayfurther comprise a lead (524) coupled to the electrode (520) and asignal generator (not shown). In some variations, the first catheter(510) may comprise an insulator (560) configured to cover a portion ofthe electrode (520). For example, the insulator (560) may be configuredto cover an outer surface of the electrode (520) where a distal end andinner surface of the electrode (520) are uninsulated.

In some variations, the ablation device (500) may comprise a secondcatheter (530) slidably disposed within the first catheter (510). Thesecond catheter (530) may comprise a barb (540) and a dilator (550)configured to engage the electrode (520). In some variations, the barb(540) may comprise a plurality of projections arranged in rows that areangled generally towards the electrode (520). For example, theprojections may be configured in rows along a length of the dilator(550). Additionally or alternatively, one or more of the projections maybe bent to form a curvilinear shape. The dilator (550) may be taperedand define a lumen (552). The electrode (520) may be proximal to thedilator (550). In some variations, the dilator (550) may comprise amating surface (554) configured to engage the electrode (520). Forexample, the electrode (520) and mating surface (554) may be configuredto compress tissue therebetween (not shown). In some variations, themating surface (554) may be non-perpendicular and non-parallel to alongitudinal axis of the second catheter (530) (e.g., chamfered,beveled). As shown in FIGS. 5A and 5B, the distal end of the electrode(520) and the mating surface (554) may be radial.

FIG. 5B is a schematic cross-sectional side view of a variation of theablation device (500) in a closed configuration. The barb (540) may beenclosed by the electrode (520), connector (526), and dilator (550) inthe closed configuration. That is, the barb (540) may be disposed withina lumen (522) of the electrode (520) when the mating surface (554)engages the electrode (520). Accordingly, any tissue engaged by the barb(540) may also be enclosed and secured within the ablation device (500)in the closed configuration by one or more of the barb (540) andelectrode (520). In some variations, an outer diameter of the dilator(550) may be less than an outer diameter of a distal end of the firstcatheter (510). For example, the outer diameter of the dilator (550) maybe less than an outer diameter of the electrode (520). This may controla shape of the tented tissue engaged by the ablation device (500). Asdescribed in more detail herein, a length and shape of the barb (540)may further control a size and shape of the tented tissue.

FIG. 6A is a schematic side view of a variation of an ablation device(600) in a closed configuration. FIG. 6A shows the ablation device (600)comprising a first catheter (610), electrode (620), dilator (650), andinsulator (660). FIG. 6B is a schematic cross-sectional side view of theablation device (600). In some variations, the ablation device (600) maycomprise a first catheter (610) and a second catheter (630). The firstcatheter (610) may comprise a tubular electrode (620) and a connector(626) coupled to the electrode (620). The electrode (620) may define alumen (622) configured to hold one or more portions of the secondcatheter (630). The first catheter (610) may further comprise a lead(624) coupled to the electrode (620) and a signal generator (not shown).In some variations, the first catheter (610) may comprise an insulator(660) configured to cover a portion of the electrode (620). For example,the insulator (660) may be configured to cover an outer surface of theelectrode (620) where a distal end and inner surface of the electrode(620) are uninsulated.

In some variations, the ablation device (600) may comprise a secondcatheter (630) slidably disposed within the first catheter (610). Thesecond catheter (630) may comprise a barb (640) and a dilator (650)configured to engage the electrode (620). In some variations, the barb(640) may comprise a plurality of projections arranged in rows that areangled generally towards the electrode (620). For example, theprojections may be configured in rows along a length of the dilator(650). Additionally or alternatively, one or more of the projections maybe bent to form a curvilinear shape. The dilator (650) may be taperedand define a lumen (652). The electrode (620) may be proximal to thedilator (650). Additionally or alternatively, one or more of theprojections may be bent to form a curvilinear shape.

In the closed configuration, the barb (640) may be enclosed by theelectrode (620), connector (626), and dilator (650). That is, the barb(640) may be disposed within a lumen (622) of the electrode (620) whenthe mating surface (654) engages the electrode (620). Accordingly, anytissue engaged by the barb (640) may also be enclosed, held, and/orsecured within the ablation device (600) in the closed configuration.

FIG. 6C is a detailed cross-sectional side view of the ablation device(600) shown in FIG. 6B. In particular, the dilator (650) may comprise amating surface (654) configured to engage the electrode (620). Forexample, the electrode (620) and mating surface (654) may be configuredto compress tissue therebetween (not shown). In some variations, themating surface (654) may be non-perpendicular and non-parallel to alongitudinal axis of the second catheter (630) (e.g., chamfered,beveled). The distal end of the electrode (620) and the mating surface(654) may be radial. As shown in FIGS. 6B and 6C, an outer diameter ofthe dilator (650) may be less than an outer diameter of the electrode(620).

FIG. 7A is a schematic side view of a variation of an ablation device(700) in an open configuration. FIG. 7A shows the ablation device (700)comprising a first catheter (710), electrode (720), second catheter(730), barb (740), dilator (750), and insulator (760). FIG. 7B is aschematic cross-sectional side view of the ablation device (700) shownin FIG. 7A. In some variations, the ablation device (700) may comprise afirst catheter (710) and a second catheter (730). The first catheter(710) may comprise a tubular electrode (720) and a connector (726)coupled to the electrode (720). The electrode (720) may define a lumen(722) configured to hold one or more portions of the second catheter(730). The first catheter (710) may further comprise a lead (724)coupled to the electrode (720) and a signal generator (not shown). Insome variations, the first catheter (710) may comprise an insulator(760) configured to cover a portion of the electrode (720). For example,the insulator (760) may be configured to cover an outer surface of theelectrode (720) where a distal end and inner surface of the electrode(720) are uninsulated.

In some variations, the ablation device (700) may comprise a secondcatheter (730) slidably disposed within the first catheter (710). Thesecond catheter (730) may comprise a barb (740) and a dilator (750)configured to engage the electrode (720). In some variations, the barb(740) may comprise a plurality of projections arranged in rows that areangled generally towards the electrode (720). For example, theprojections may be configured in rows along a length of the dilator(750). Additionally or alternatively, one or more of the projections maybe bent to form a curvilinear shape. The dilator (750) may be taperedand define a lumen (752). The electrode (720) may be proximal to thedilator (750).

FIG. 7C is a detailed cross-sectional side view of the ablation device(700) shown in FIG. 7B. In particular, the dilator (750) may comprise amating surface (754) configured to engage the electrode (720). Forexample, the electrode (720) and mating surface (754) may be configuredto compress tissue therebetween (not shown). In some variations, themating surface (754) may be non-perpendicular and non-parallel to alongitudinal axis of the second catheter (730) (e.g., chamfered,beveled). The distal end of the electrode (720) and the mating surface(754) may be radial.

FIGS. 8-10B illustrate additional ablation device variations. FIG. 8 isa perspective view of a variation of an ablation device (800). In somevariations, the ablation device (800) may comprise a first catheter(810) and a second catheter (830). The first catheter (810) may comprisea tubular electrode (820). The electrode (820) may define a lumen (822)configured to hold one or more portions of the second catheter (830).The electrode (820) shown in FIG. 8 has a cylindrical shape. However,the electrode (820) may comprise any desired cross-sectional shape(e.g., oval, square, rectangular, triangular).

In some variations, the ablation device (800) may comprise a secondcatheter (830) slidably disposed within the first catheter (810). Thesecond catheter (830) may comprise a barb (840) and a dilator (850)configured to engage the electrode (820). In some variations, the barb(840) may be coupled to a proximal portion of the dilator (850). Thebarb (840) may comprise a tapered portion and a plurality of projectionsdisposed radially about the barb (840) and arranged in staggered rowsalong a length of the second catheter (830). Tissue engaged by one ormore of the projections may form a generally conical shape thatgenerally follows the tapered shape of the barb (840). The plurality ofprojections may have the same or different length, diameter, and taper.Each row may have the same or different number of projections. Theplurality of projections may have the same or different angle relativeto the second catheter (830).

In some variations, the plurality of projections (e.g., tissueengagement portions) of the barb (840) may be generally parallel to alongitudinal axis of the second catheter (830). In some variations, aproximal portion of the dilator (850) may be configured to contact theelectrode (820) when the second catheter (830) is withdrawn relative tothe first catheter (810). The dilator (850) may have, for example, agenerally conical shape that tapers toward a distal end of the secondcatheter (830). However, the dilator (850) may comprise anypredetermined size, pattern, and shape.

As described in more detail herein, the second catheter (830) may beconfigured to translate relative to the first catheter (810). Forexample, the second catheter (830) may translate along a longitudinalaxis of the first catheter (810). In some variations, one or more of thesecond catheter (830), barb (840), and dilator (850) may translate intothe lumen (822) of the electrode (820). As described in more detailherein, the electrode (820) may be configured to ablate tissuecompressed between a distal end of the electrode (820) and the dilator(850).

FIG. 9A is a schematic side view of a variation of an ablation device(900) in a closed configuration. FIG. 9A shows the ablation device (900)comprising a first catheter (910), electrode (920), and dilator (950).FIG. 9B is a schematic cross-sectional side view of the ablation device(900). In some variations, the ablation device (900) may comprise afirst catheter (910) and a second catheter (930). The first catheter(910) may comprise a tubular electrode (920) and a connector (926)coupled to the electrode (920). The electrode (9620) may define a lumen(922) configured to hold one or more portions of the second catheter(930) (e.g., barb (940)). The first catheter (910) may further comprisea lead (not shown) coupled to the electrode (920) and a signal generator(not shown). In some variations, the first catheter (910) may comprisean insulator (960) configured to cover a portion of the electrode (920).For example, the insulator (960) may be configured to cover an outersurface of the electrode (920) such that a distal end and inner surfaceof the electrode (920) are uninsulated.

In some variations, the ablation device (900) may comprise a secondcatheter (930) slidably disposed within the first catheter (910). Thesecond catheter (930) may comprise a barb (940) and a dilator (950)configured to engage the electrode (920). In some variations, the barb(940) may comprise a plurality of projections arranged in rows that aregenerally parallel to a longitudinal axis of the second catheter (930).For example, the projections may be configured in rows along a length ofthe second catheter (930). Additionally or alternatively, one or more ofthe projections may be bent to form a curvilinear shape. The dilator(950) may be tapered and define a lumen (952). In some variations, thedilator (950) may comprise a mating surface (954) configured to engagethe electrode (920). For example, the electrode (920) and mating surface(954) may be configured to compress tissue therebetween (not shown). InFIG. 9B, the mating surface (954) is generally perpendicular to thelongitudinal axis of the second catheter (930). The electrode (920) maybe proximal to the dilator (950). The distal end of the electrode (920)and the mating surface (954) may be radial.

In the closed configuration, the barb (940) may be enclosed by theelectrode (920), connector (926), and dilator (950). That is, the barb(940) may be disposed within a lumen (922) of the electrode (920) when amating surface (954) of the dilator (950) engages the electrode (920).Accordingly, any tissue engaged by the barb (940) may also be enclosed,held, and/or secured within the ablation device (900) in the closedconfiguration.

FIG. 10A is a schematic side view of a variation of an ablation device(1000) in an open configuration. FIG. 10A shows the ablation device(1000) comprising a first catheter (1010), electrode (1020), secondcatheter (1030), barb (1040), and dilator (1050). FIG. 10B is aschematic cross-sectional side view of the ablation device (1000) shownin FIG. 10A. In some variations, the ablation device (1000) may comprisea first catheter (1010) and a second catheter (1030). The first catheter(1010) may comprise a tubular electrode (1020) and a connector (1026)coupled to the electrode (1020). The electrode (1020) may define a lumen(1022) configured to hold one or more portions of the second catheter(1030). The first catheter (1010) may further comprise a lead (notshown) coupled to the electrode (1020) and a signal generator (notshown). In some variations, the first catheter (1010) may comprise aninsulator (1060) configured to cover a portion of the electrode (1020).For example, the insulator (1060) may be configured to cover an outersurface of the electrode (1020) such that a distal end and inner surfaceof the electrode (1020) are uninsulated.

In some variations, the ablation device (1000) may comprise a secondcatheter (1030) slidably disposed within the first catheter (1010). Insome variations, the barb (1040) may comprise a plurality of projectionsarranged in rows that are generally parallel to a longitudinal axis ofthe second catheter (1030). For example, the projections may beconfigured in rows along a length of the second catheter (1030).Additionally or alternatively, one or more of the projections may bebent to form a curvilinear shape. The dilator (1050) may be tapered anddefine a lumen (1052). In some variations, the dilator (1050) maycomprise a mating surface (1054) configured to engage the electrode(1020). For example, the electrode (1020) and mating surface (1054) maybe configured to compress tissue therebetween (not shown). In FIG. 10B,the mating surface (1054) is generally perpendicular to the longitudinalaxis of the second catheter (1030). The electrode (1020) may be proximalto the dilator (1050). The distal end of the electrode (1020) and themating surface (1054) may be radial.

FIG. 38A is a schematic cross-sectional side view of a variation of anablation device (3800) in a closed configuration. In some variations,the ablation device (3800) may comprise a first catheter (3810) and asecond catheter (3830). The first catheter (3810) may comprise aelectrode (3820) such as a tubular electrode. The electrode (3820) maydefine a lumen configured to hold one or more portions of the secondcatheter (3830). The first catheter (3810) may further comprise a firstcatheter actuator (3822) (e.g., lead, electrical pull wire) coupled tothe electrode (3820) and a signal generator (not shown). As described inmore detail herein, the first catheter actuator (3822) may be configuredto deliver electrical energy to the electrode (3820) as well as deflecta distal portion of the ablation device (3800) in the manner of a pullwire. In some variations, the first catheter (3810) may comprise aninsulator (3824) configured to cover a portion of the electrode (3820).For example, the insulator (3824) may be configured to cover an outersurface of the electrode (3820) where a distal end and an inner surfaceof the electrode (3820) are uninsulated. In some variations, the firstcatheter (3810) may comprise a contrast agent lumen (3812) as describedin more detail herein.

In some variations, the ablation device (3800) may comprise a secondcatheter (3830) slidably disposed within the first catheter (3810). Thesecond catheter (3830) may comprise a barb (3840) and a dilator (3850)configured to engage the electrode (3820). In some variations, the barb(3840) may comprise a plurality of projections (3842, 3844) radiallyarranged that generally extend towards the electrode (3820). Forexample, the projections (3842) may comprise a distal portion (38′12)configured to pierce tissue and the projections (3844) may comprise aproximal portion configured as a backstop to tissue.

In some variations, the dilator (3850) may be tapered and define a lumen(3852). In some variations, a guidewire (not shown) may be slidablydisposed within the lumen (3852). In some variations, the dilator (3850)may comprise a proximal portion (3854) and an echogenic region (notshown). For example, the echogenic region may comprise a predeterminedsurface texture configured for visualization using ultrasonic imaging.The proximal portion (3854) of the dilator (3850) may be configured toengage the electrode (3820) in the closed configuration. That is, theproximal portion (3854) may be configured to be in a lumen of theelectrode (3820) in the closed configuration of the ablation device(3800). In some variations, the dilator (3850) may comprise a matingsurface (3856) configured to engage the electrode (3820). For example,the electrode (3820) and mating surface (3856) may be configured tocompress tissue therebetween (not shown) as discussed in more detailwith respect to FIG. 36A. The mating surface (3856) of the dilator(3850) may extend radially and/or lengthwise.

In the closed configuration, the barb (3840) may be enclosed by thefirst catheter (3810), electrode (3820), and dilator (3850). That is,the barb (3840) may be disposed within a lumen of the electrode (3820)when the proximal portion (3854) (e.g., mating surface (3856)) engages(e.g., is seated within) the electrode (3820). Accordingly, any tissueengaged by the barb (3840) may also be enclosed and secured within theablation device (3800) in the closed configuration by one or more of thebarb (3840) and electrode (3820). The proximal portion (3854) arrangedwithin the lumen of the electrode (3820) may securely and coaxiallyattach the electrode (3820) to the dilator (3850). For example, thedilator (3850) may be secured to the first catheter (3810) to withstanddislodgment from a lateral load such as when the ablation device (3800)is tracked over a curved guidewire. Furthermore, the electrode (3820)securely engaged to the dilator (3850) may be configured to prevent theablation device (3800) from catching (e.g., snagging) against a vessel,tissue (e.g., transseptal crossing), introducer, sheath, and the likeduring advancement and withdrawal through a body cavity. In somevariations, between about 0.5 mm and about 2 mm of the proximal portion(3854) of the dilator (3850) may be disposed within the lumen of theelectrode (3820) when the mating surface engages the electrode (3820).

FIG. 38B is a schematic cross-sectional side view of a variation of theablation device (3800) in an open configuration. The second catheter(3830) may be configured to translate relative to the first catheter(3810) via an actuation mechanism of a handle such as described hereinwith respect to FIGS. 39A and 39B. FIG. 36A illustrates an ablationdevice (3600) in a cutting configuration between the open configurationand closed configuration. The ablation device (3600) may correspond tothe ablation device (3800).

In some variations, a proximal portion (3854) of the dilator (3850) maycomprise a first step portion comprising a first diameter and a secondstep portion comprising a second diameter greater than the firstdiameter. The first step portion may be proximal to the second stepportion. In some variations, the second step may comprise the matingsurface (3856) configured to engage a distal end of the electrode(3820). In some variations, the mating surface (3856) may besubstantially perpendicular to a longitudinal axis of the dilator(3850). In some variations, the first step may be configured to engage asidewall of the electrode (3820) when the dilator (3850) engages theelectrode (3820). In some variations, the dilator (3850) may beconfigured to attach to the first catheter (3810) when the dilator(3850) engages the electrode (3820).

Electrode

Generally, the electrodes described here may be configured to ablatetissue such as a portion of an interatrial septum of a patient to reduceblood pressure in a left atrium of a patient. In some variations, theelectrode may engage the septum and be energized to excise a portion ofseptum tissue to form a predetermined opening between the left atriumand right atrium. For example, tissue may be heated using radiofrequency(RF) energy during an electrosurgical procedure. RF energy tissueablation may be used to quickly and precisely cut tissue withoutsignificant damage to surrounding tissue. In some variations, RF energymay be delivered to tissue by an electrode to quickly and precisely cuttissue so as to form an anastomosis of a predetermined shape and size.

In some variations, tissue ablation characteristics may be controlled bythe size, shape, and/or geometry of the conductive region of theelectrode. For example, the electrode may comprise a thin, radial edgeconfigured to apply high density energy to a small contact surface areaof tissue being cut. This may cut tissue quickly and with less energyrelative to an electrode having a larger contact surface area. In somevariations, a distal end of the electrode may be angled (e.g.,chamfered, beveled) relative to a longitudinal axis of the electrode tofurther reduce a contact surface area of the electrode with respect totissue. In some variations, a width of the chamfered surface may bebetween about 0.025 mm and about 0.040 mm, including all ranges andsub-values in-between. For example, a width of the chamfered surface maybe between about 0.05 mm and about 0.08 mm.

Furthermore, a small contact surface area of the electrode may aidcompression of the tissue prior to ablation. For example, as shown inFIGS. 6A-6C and FIGS. 9A-9B, a distal end of the electrode (620, 920)may be configured to abut against a corresponding mating surface (654,954). A smaller contact surface area of the electrode may increase thecompression force applied to tissue against the mating surface.Compression of the tissue between the electrode and mating surface mayprovide numerous benefits. For example, reducing the thickness of thetissue to be cut via compression may allow the septum to be cut fasterand with less energy. Furthermore, compressed tissue may hold (e.g.,secure, lock) the tissue in place relative to the ablation device toensure that only a predetermined portion of tissue is cut. In somevariations, compression of the tissue during activation may fuse layersof tissue (e.g., left and right atrial septal layers) together duringablation, thereby reducing a surface area of exposed tissue along aperimeter of the anastomosis after tissue excision. In some variations,compression of tissue may be used to reduce the volume of tissue, thusenabling a larger volume of tissue to be contained within the lumen ofthe electrode following ablation, thereby allowing a relatively largeranastomosis to be formed.

In some variations, a shape of the opening in the interatrial septum maybe based on a shape of the electrode. For example, the electrodes (420,820) in respective FIGS. 4 and 8 may comprise a tubular shape that maybe used to generate a generally circular opening. In some variations, atleast a portion of a distal end of an electrode may be angled betweenabout 5 degrees and about 75 degrees relative to a longitudinal axis ofthe electrode so as to form a chamfer and/or bevel. For example, atleast a portion of a distal end of an electrode may be angled betweenabout 30 degrees and about 60 degrees relative to a longitudinal axis ofthe electrode. For example, a distal end (628, 728) of the electrode(620, 720) in respective FIGS. 6C and 7C may be radially angled at abouta 45 degree angle relative to the longitudinal axis of the electrode(620, 720).

As discussed herein, a chamfered electrode may reduce a contact surfacearea of the electrode and allow for increased compression force ontissue. In some variations, a corresponding mating surface of a dilatormay be similarly chamfered to aid alignment and coupling of the dilatorto the electrode as the dilator is withdrawn relative to the electrode.In some variations, at least a portion of a mating surface of a dilatormay be angled between about 5 degrees and about 75 degrees relative to alongitudinal axis of the dilator. For example, at least a portion of amating surface of a dilator may be angled between about 30 degrees andabout 60 degrees relative to a longitudinal axis of the dilator. In thismanner, the chamfered electrode may allow the dilator to seat itselfinto the electrode by providing tolerance for misalignment between theelectrode and dilator due to, for example, tissue disposed therebetween.

In some variations, one or more portions of an electrode may be coveredby an insulator (e.g., PTFE, ePTFE, PET, polyolefin, parylene, FEP,silicone, nylon, PEEK, polyimide) to reduce the contact surface area ofthe electrode. A relatively small contact surface area may reduce vaporbubble formation, as well as char formation and activation time of theelectrode. In some variations, an inner surface of the electrode mayremain uninsulated and serve as a conduction pathway for current totravel through the contained tissue during and after tissue excision. Insome variations, conduction through the tissue may shrink the volume ofexcised tissue via dessication and/or denaturation of protein, therebyenabling containment of larger volumes of tissue.

FIGS. 11A and 11B are schematic cross-sectional side views of anelectrode (1110) of an ablation device (1100). In particular, a distalend of a first catheter may comprise the electrode (1110) having adistal end (1120), insulator (1130), lead (1140), and connector (1150).The electrode (1110) may have a tubular shape comprising a distal end(1120) and defining a lumen (1112). In some variations, the lumen (1112)may be configured to enclose one or more of a barb, tissue engaged bythe barb, and a proximal portion of a dilator. FIG. 5A illustrates across-sectional perspective view of lumen (522) and FIG. 5B shows a barb(540) and a portion of a dilator (550) disposed within the lumen (522).Furthermore, as shown in FIG. 22, the lumen (2222) may have a volumesufficient to enclose a predetermined volume of tissue (2260).Similarly, FIGS. 27A and 27B are images including a predetermined volumeof tissue (2760) that fit within a lumen of an electrode (2720). As yetanother example, the tissue (2860) shown in FIGS. 28A and 28B isconfigured to fit within a lumen of an electrode (not shown). In somevariations, the lumen may have a length of at least 1 mm. For example,the lumen may have a length between about 5 mm and about 4 cm.

In some variations, the connector (1150) may couple to each of theelectrode (1110) and lead (1140). The insulator (1130) may be configuredto cover an outer surface of one or more of the electrode (1110) andconnector (1150). In some variations, the inner surface of the electrode(1110) may be uninsulated. In some variations, up to about 2 mm of anouter surface of an electrode may be uninsulated. For example, up toabout 0.15 mm of an outer surface of an electrode may be uninsulated.

As shown in the detailed cross-sectional side view of FIG. 11B, a distalend (1120) of the electrode (1110) may be angled (e.g., chamfered,beveled) relative to a longitudinal axis of the electrode (1110). Insome variations, the chamfer may extend radially along the distal end(1120). The distal end (1120) may comprise a single angle or a pluralityof angles. For example, a surface of the distal end (1120) may comprisea sine-wave like shape where a corresponding mating surface of a dilatormay comprise a corresponding sine-wave like shape. This may allow therespective mating surfaces of the electrode and dilator to contact andcompress each other in a predetermined orientation.

In some variations, the electrode may comprise one or more biocompatiblemetals such as titanium, stainless steel, nitinol, palladium, silver,platinum, combinations thereof, and the like. In some variations, theelectrode may comprise an atraumatic (e.g., blunt, rounded) distal edgesuch that the electrode does not puncture tissue when pressed against anopposing surface such as a mating surface of a dilator. For example, theelectrode may engage and compress the tissue along its chamferedcircumferential edge.

In some variations, the cut tissue may comprise a diameter of betweenabout 1 mm and about 1.5 cm, including all ranges and sub-valuesin-between. For example, the cut tissue may comprise a diameter ofbetween about 0.5 mm and about 12 mm. For example, the cut tissue maycomprise a diameter of between about 6 mm and about 9 mm.

In some variations, the heating of tissue may shrink the tissue prior tocutting. In some variations, the heating of tissue may shrink the tissueafter cutting. In some variations, the tissue may be heated to apredetermined range of temperatures. In some variations, the tissue tobe cut may be heated to at least about 60° C., about 70° C., about 80°C., about 90° C., and about 100° C. for a predetermined amount of time.In some variations, the tissue to be cut may be heated between about 50°C. and about 100° C. for a predetermined amount of time. In somevariations, only the tissue to be cut may be heated, while in othervariations, only part of the tissue to be cut may be heated. In somevariations, the electrode may be configured to rotate, oscillate, and/orvibrate during and subsequent to energy delivery to prevent, minimize,and/or disrupt char formation.

In some variations, the electrode may be connected by a lead (e.g.,conductive wire) to a signal generator. The lead may extend from aproximal portion of the first catheter to the electrode at a distalportion of the first catheter. One or more portions of the lead may beinsulated. The lead may be configured to sustain a predetermined voltagepotential without dielectric breakdown of its corresponding insulation.

FIGS. 12A and 12B are respective perspective and front views of aconnector (1200) of an ablation device. FIG. 12C is a cross-sectionalside view of the connector (1200). In some variations, the connector(1200) may be configured to couple an electrode and lead to a shaft of afirst catheter (not shown for the sake of clarity). The connector (1200)may comprise a lumen (1210) configured to slidably dispose a secondcatheter, and a channel (1220) configured for a distal end of a lead. Insome variations, at least a portion of the inner surface of theconnector (1200) may be lubricious to aid translation of the secondcatheter relative to the connector (1200). For example, an inner surfaceof the connector (1200) may comprise a layer of PTFE to facilitatelubricious translation and/or rotation of a second catheter slidablydisposed within the lumen (1210). In some variations, a connector (1200)may comprise a vent lumen (not shown) configured to vent fluid (e.g.,air, heat, liquid) from a lumen of the electrode to a lumen of a firstcatheter.

In some variations, the connector (1200) may comprise a length of atleast 0.1 mm. For example, the connector (1200) may comprise a length ofbetween about 1 mm and about 2 cm, and between about 2 mm and about 7mm. In some variations, the lumen (1210) may comprise a length of atleast 0.1 mm. For example, the lumen (1210) may comprise a length ofbetween about 1 mm and about 1 cm. In some variations, the channel(1220) may comprise a length of at least 0.1 mm. For example, thechannel (1220) may comprise a length of between about 1 mm and about 5mm.

In some variations, the systems disclosed herein may comprise a returnelectrode (e.g., RF energy sink) to draw RF energy out of the patient.In some variations, a second catheter may comprise a return electrode.In some variations, the return electrode may be external to and incontact with the return electrode (e.g., a skin patch electrode,grounding pad). For example, a set of return electrodes may be disposedon a back of a patient to allow current to pass from the electrodethrough the patient and then to the return electrode. For example, oneor more return electrodes may be disposed on a skin of a patient. Aconductive gel may be applied between the return electrodes and the skinto improve contact.

Insulator

Generally, the insulators described here may be configured toelectrically isolate one more portions of the electrode and/or cathetersof the ablation device. In some variations, the insulator may compriseone or more of a poly(p-xylylene) polymer such (e.g. parylene C,parylene N), polyurethane (PU), polytetrafluoroethylene (PTFE), expandedPTFE (ePTFE), polyimide (PI), polyester, polyethylene terephthalate(PET), PEEK, polyolefin, silicone, copolymer, a ceramic, combinationsthereof, and the like.

Barb

Generally, the barbs described here may be configured to engage tissuesuch as an interatrial septum of a patient to control a size and shapeof the septum tissue to be cut. In some variations, a portion of septumtissue may be engaged by one or more projections of the barb andstretched across one or more projections to hold tissue in place beforeand after tissue ablation. In some variations, the projections may beconfigured to penetrate a predetermined distance into the tissue orthrough the tissue. For example, the projections may be configured topenetrate through multiple layers of the interatrial septum (e.g., oneor more left atrium layers and right atrium layers) to secure the septumtissue to the barb while maintaining the structural integrity of theseptum as a whole. In some of these variations, penetration of theprojections through the tissue may hold the tissue to the barb to reducethe shearing strain of the tissue as it is pulled into the electrode,thereby improving the consistency and shape (e.g., cylindricity) of thecut. That is, the barb may be configured to capture but not tear tissuesuch that the tissue may remain engaged by the barb throughout anelectrosurgical procedure.

For example, the barb may be configured to prevent tearing bydistributing pressure as tissue is engaged and pulled. For example, theengaged tissue may form a generally conical tent-like shape over thebarb to apply tension to the septum. In some variations, a barb may beconfigured to provide counter tension to the interatrial septum duringenergization of the electrode so as to minimize any unintended tissuedeformation, rotation, and displacement due to unbalanced forces (e.g.,tissue motion due to the heart beating). The engaged tissue and barb maybe withdrawn into a lumen of an ablation device to hold and secure thetissue during tissue ablation. In some variations, the size of ananastomosis may depend on the distance the barb is withdrawn into theelectrode such that a size of an anastomosis may be independent of thediameter of the ablation device. This allows an ablation device havingan electrode with a fixed diameter to form an anastomosis having adiameter larger than that of the electrode. The size (e.g., diameter,length) and shape of the barb should be such that it may fit within alumen of an electrode while engaged to tissue. In some variations, adiameter of an opening in tissue may be calculated using equation (1):

$\begin{matrix}{D = {2\sqrt{\left( \frac{d}{2} \right)^{2} + z^{2}}}} & (1)\end{matrix}$where, D is a diameter of the opening, d is an inner diameter of anelectrode, and z is a distance the tissue is pulled into the electrode.

FIGS. 13A-13C depict various views of a barb (1300) of an ablationdevice. The barb (1300) may comprise a base (1310) and one or moreprojections (1320) (e.g., prongs) having a proximal end comprising atissue engagement portion (1322) (e.g., point). The base (1310) may begenerally cylindrical and configured to couple to a proximal portion ofa dilator and a shaft of a second catheter (not shown). For example, thebase (1310) may be proximal to a dilator of the second catheter.

One or more of the projections (1320) may couple to a proximal end ofthe base (1310). In some variations, the projection (1320) may comprisean elongate element. For example, the barb (1300) may comprise at leastone projection (1320). In some variations, the projections (1320) may bespaced apart substantially equally about a circumference of the base(1310). In some variations, each of the projections (1320) may have thesame or different lengths. In some variations, a length of the barb(1300) may be between about 0.1 mm and about 5 cm. In some variations,one or more of the projections (1320) may be linear, bent, curvilinear,rounded, arcuate, and the like.

In some variations, the projection (1320) may comprise one or moretissue engagement portions (1322). The tissue engagement portion (1322)and/or projection (1320) may be configured to engage tissue while nottearing the tissue to prevent a loss of tissue integrity. In somevariations, the tissue engagement portion (1322) may be configured topierce or penetrate through the tissue. In some variations, the geometryand size of each tissue engagement portion (1322) may be the same ordifferent. For example, the tissue engagement portion (1322) maycomprise a sharp point or a blunt, atraumatic end. In some variations,the tissue engagement portion (1322) may comprise one or more secondarystructures (e.g., serrations) to prevent tissue from sliding down theprojection (1320). In some variations, the tissue engagement portion(1322) may comprise an angle of between about 10 degrees and about 90degrees relative to a longitudinal axis of its projection (1320). Insome variations, a length of the projection (1320) and/or tissueengagement portion (1322) may be between about 0.1 mm and about 2 cm.

In some variations, the projections (1320) may be generally linear, butmay be angled relative to a longitudinal axis of the base (1310). Forexample, the projections (1320) may be configured to splay outward tocatch and engage tissue. In some variations, the projections maycomprise one or more curved or angulated portions. In some variations,tissue may be configured to engage one or more portions of theprojection (1320). In some variations, a projection of the barb may beangled between about 5 degrees and about 60 degrees relative to thelongitudinal axis of the base (1310), including all values andsub-ranges in-between. For example, the projection (1320) may comprisean angle of between about 30 degrees and about 45 degrees. Eachprojection (1320) may have the same angle or a different angle relativeto the longitudinal axis.

In some variations, the projection (1320) may be configured to engage apredetermined length and/or volume of tissue. For example, theprojection (1320) may comprise a proximal portion configured as abarrier (e.g., backstop, wall) against additional tissue engagement(e.g., advancement, penetration), thereby reducing tissue tearing.

FIG. 14 is a schematic side view of a barb (1400) of an ablation device.The barb (1400) may comprise a base (1410) and one or more projections(1420) having a proximal end comprising a tissue engagement portion(1422). The projections (1420) of the barb (1400) may be angled in asimilar manner as the barb (1300) of FIGS. 13A-13C. In some variations,a barb may comprise between about 2 projections and about 12projections, including all values and sub-ranges in-between. Forexample, a barb my comprise between about 5 projections and about 7projections.

FIG. 15A is a schematic side view of a barb (1500) of an ablationdevice. FIG. 15B is a front view of the barb (1500). The barb (1500) maycomprise a base (1510) and one or more projections (1520, 1530) havingrespective proximal ends each comprising a respective tissue engagementportion (1522, 1532). In some variations, one or more projections (1520,1530) may be configured in rows along a length of the barb (1500). Forexample, the barb (1500) may comprise one or more rows of projections(1520, 1530). In some variations, the rows of projections (1520, 1530)may be staggered such as shown in FIGS. 15A and 15B. Tissue engaged tothe barb (1500) may form a generally conical tent-like shape.

FIG. 16 is a schematic side view of a barb (1600) of an ablation device.The barb (1600) may comprise a base (1610) and one or more projections(1620) having a proximal end comprising a tissue engagement portion(1622). The projections (1620) may be parallel to a longitudinal axis ofthe base (1610). FIGS. 17A and 17B are respective schematic side andperspective views of a barb (1700) of an ablation device. The barb(1700) may comprise a base (1710) and one or more projections (1720)having a proximal end comprising a tissue engagement portion (1722). Thetissue engagement portions (1722) may extend along a majority of alength of the projection (1720). In some variations, the base (1610) maycomprise a diameter less than a diameter of an electrode. In somevariations, the projections (1620, 1720) and tissue engagement portions(1622, 1722) may comprise a length configured to pierce through aninteratrial septum. One or more tissue engagement portions (1722) maycomprise a length, as shown in FIGS. 17A and 17B that may aid piercingand/or penetration of tissue with reduced force due to an increasedtaper

FIGS. 41A and 41B are respective schematic side and perspective views ofa barb (4100) of an ablation device. The barb (4100) may comprise a base(4110) and one or more projections (4120) having a proximal endcomprising a tissue engagement portion (4122). In some variations, theprojections (4120) and tissue engagement portions (4122) may comprise alength configured to pierce through an interatrial septum. One or moretissue engagement portions (4122) may comprise a length, as shown inFIGS. 41A and 41B that may aid piercing and/or penetration of tissue.

FIGS. 26A-26C depict various views of a barb (2600) of an ablationdevice. The barb (2600) may comprise a base (2610) and one or moreprojections (2620) (e.g., prongs, tines). The projection (2620) maycomprise a first portion (2624) and a distal portion (e.g., tissueengagement portion) (2622) (e.g., tip, point). In some variations, thefirst portion (2624) may be angled relative to the second portion(2622). For example, the projection (2620) may comprise a bend where thefirst portion (2624) is substantially perpendicular to the secondportion (2622). The base (2610) may be generally cylindrical andconfigured to couple to a proximal portion of a dilator and a shaft of asecond catheter (not shown). For example, the base (2610) may beproximal to a dilator of the second catheter.

One or more of the projections (2620) may couple to an end of the base(2610). In some variations, the projection (2620) may comprise anelongate element. For example, the barb (2600) may comprise at least oneprojection (2620). In some variations, the projections (2620) may bespaced apart substantially equally about a circumference of the base(2610) and extended away from a longitudinal axis of the base (2610). Insome variations, each of the projections (2620) may have the same ordifferent lengths. In some variations, a length of the barb (2600) maybe between about 0.1 mm and about 5 cm. In some variations, a length ofthe proximal portion to a length of the distal portion may be in a ratiobetween about 2:3 and about 1:5. In some variations, one or more of theprojections (2620) may be linear, bent, curvilinear, rounded, arcuate,and the like. For example, projection (2610) may comprise an “L” shape,“J” shape, or “C” shape where the projections (2610) collectively definea diameter greater than a diameter of the base (2610).

In some variations, the distal portion (2620) of a projection (2620) maycomprise one or more tissue engagement portions (2622). The tissueengagement portion (2622) and/or projection (2620) may be configured toengage tissue while not tearing the tissue to prevent a loss of tissueintegrity. In some variations, the tissue engagement portion (2622) maybe configured to pierce or penetrate through the tissue. In somevariations, the geometry and size of each tissue engagement portion(2622) may be the same or different. For example, the tissue engagementportion (2622) may comprise a sharp point or a blunt, atraumatic end. Insome variations, the tissue engagement portion (2622) may comprise oneor more secondary structures (e.g., serrations) to prevent tissue fromsliding down the projection (2620). In some variations, the tissueengagement portion (2622) may be substantially parallel to alongitudinal axis of the base (2620). In some variations, a length ofthe projection (2620) may be between about 0.1 mm and about 2 cm. Forexample, the projection (2620) may comprise a length of between about1.25 mm and about 1.75 mm, and about 1.5 mm. In some variations, alength of the tissue engagement portion (2622) may be between about 1.0mm and about 1.5 mm, including all ranges and sub-values in-between.

In some variations, the projections (2620) may be generally linear, butmay comprise one or more bends. For example, a first portion (2624) ofthe projection (2620) may be configured to extend substantiallyperpendicularly to a longitudinal axis of the base (2620). In somevariations, the projections may comprise one or more curved or angulatedportions between the first portion (2624) and second portion (2622). Insome variations, tissue may be configured to engage one or more portionsof the projection (2620).

In some variations, a first portion (2624) of a projection (2622) may beangled between about 60 degrees and about 120 degrees relative to thelongitudinal axis of the base (2610), including all values andsub-ranges in-between. For example, the projection (2620) may comprisean angle of between about 80 degrees and about 100 degrees relative tothe longitudinal axis of the base (2610). As shown in FIG. 26A, thefirst portion (2624) may be substantially perpendicular to thelongitudinal axis of the base (2610). Each first portion (2624) of theprojection (2620) may have the same angle or a different angle relativeto the longitudinal axis. In some variations, a second portion (2622) ofa projection (2620) may be angled up to about 30 degrees relative to thelongitudinal axis of the base (2610). For example, as shown in FIG. 26A,the second portion (2622) may be substantially parallel to thelongitudinal axis of the base (2610).

In some variations, the projection (2620) may be configured to engage apredetermined length and/or volume of tissue. For example, the secondportion (2622) may engage and pierce the tissue while the first portion(2624) may engage and secure the tissue to the barb (2600). The secondportion (2622) may be configured to pierce through tissue such that thelayers of an interatrial septum (e.g., left and right atrium layers) areheld together to reduce tissue separation and/or tissue shearing. Forexample, the projection (2620) may be configured to penetrate and staplethe various layers of the septum together to reduce relative shearing ofseptal tissue layers during translation, thereby reducing chamfering ofthe anastomosis to be formed. The first portion (2624) may further beconfigured as a barrier (e.g., backstop, wall) against additional tissueengagement (e.g., advancement, penetration), thereby reducing tissuetearing. A predetermined volume of tissue may be captured by theprojections (2620) as the barb is withdrawn into a lumen of theelectrode.

In some variations, a barb may comprise between about 3 projections andabout 12 projections, including all values and sub-ranges in-between.For example, a barb may comprise between about 3 projections and about 7projections. In some variations, a plurality of tissue engagementportions (2622) may extend from the same first portion (2624) that maycollectively comprise, for example, a set of concentric rings. In somevariations, the set of projections may be staggered. Tissue engaged tothe barb (2600) may form a generally conical or cylindrical tent-likeshape. In some variations, the tissue engagement portions (2622) mayextend along a majority of a length of the projection (2620). In somevariations, the base (2610) may comprise a diameter less than a diameterof an electrode.

In some variations, the barb may be configured to transition from acompressed configuration to an expanded configuration. For example, thebarb may be in a compressed configuration when disposed within a lumenof an electrode. The barb may transition to an expanded configurationwhen the second catheter is advanced relative to the first catheter suchthat the barb is advanced out of the lumen of the electrode, therebyallowing the barb engage a large volume of tissue.

In some variations, a barb may be configured to engage tissue forcutting by rolling the barb (2920) by a predetermined angle. FIGS. 29A,29B, and 29C are side views of a barb (2920) of an ablation device(2900) in an endocardial space. The ablation device (2900) may comprisea catheter (2910) (e.g., distal tip, dilator) and a barb (2920). Thebarb (2920) may comprise a base (2926) and one or more projections(e.g., prongs, tines) comprising a second portion (e.g., tissueengagement portion) (2922) (e.g., tip, point) and a first portion(2924).

In some variations, the second portion (2922) (e.g., tissue engagementportion) may be configured to engage tissue (2930) while not tearing thetissue to prevent a loss of tissue integrity. In some variations, thesecond portion (2922) may be configured to pierce or penetrate throughthe tissue. FIG. 29A depicts initial penetration of the tissue (2930) bythe second portion (2922). As the barb (2920) is advanced towards thetissue (2930), FIG. 29B depicts penetration of the second portion (2922)through the entire thickness of the tissue (2930) (e.g., interatrialseptum).

In some variations, a size (e.g., diameter) of the tissue (2930) to becut may be controlled by rolling (e.g., twisting) the barb (2920) abouta longitudinal axis (2921) of its base (2926). For example, rolling thebarb (2920) after engagement with tissue (2930) (FIG. 29B) may increasean amount of tissue (2930) engaged to the barb (2920) to be cut. As thebarb is rolled, tissue (2930) may be drawn toward (e.g., compressed)(2932) the longitudinal axis (2921) by the arrows (2932), as shown inFIG. 29C. This may enable a diameter (2934) of the tissue (2930) to becut to be greater than a diameter of the barb (2920). In somevariations, twisting the barb may increase a diameter of the tissue tobe up to about 5 mm, up to about 3 mm, and up to about 1 mm, includingall ranges and sub-values in-between.

In some variations, the barb (2920) may be configured to roll up toabout 30 degrees, up to about 45 degrees, up to about 60 degrees, up toabout 90 degrees, up to about 180 degrees, up to about 270 degrees, upto about 360 degrees, up to about 720 degrees, up to about 1,080degrees, between about 90 degrees and about 720 degrees, and betweenabout 180 degrees and about 360 degrees, including all ranges andsub-values in-between.

In some variations, a handle of the device may be configured to controlrotation of the barb (2920) and/or catheter (2910), and therefore enablecontrol of a size of the tissue (2930) to be cut. In some variations, aproximal portion of an ablation device (e.g., first catheter) may befixed relative to a rotating distal portion of the ablation device(e.g., barb (2920) and catheter (2910).

In some variations, the first portion (2924) may be angled relative tothe second portion (2922) in a similar manner as described in detailherein with respect to FIGS. 26A-26C. In some variations, the projectionmay comprise a bend where the first portion (2924) is at an acute anglerelative to the second portion (2922). For example, as shown in FIGS.29A-29C, the first portion (1924) is at an acute angle relative to alongitudinal axis (2921) of the base (2926). The base (2926) may begenerally cylindrical and configured to couple to a proximal portion ofa catheter (2910) (e.g., second catheter, distal catheter). For example,the base (2926) may be proximal to a dilator (not shown in FIGS.29A-29C).

In some variations, a barb may be configured to translate relative tothe dilator (3030) to transition between a first configuration (e.g.,recessed configuration) and a second configuration (e.g., extendedconfiguration). FIGS. 30A and 30B, are cross-sectional side views of adistal portion of an ablation device (3000) comprising a catheter (3010)(e.g., second catheter), barb (3020), and distal tip (3030) (e.g.,dilator). In some variations, the catheter (3010) and/or dilator (3030)may comprise one or more lumens (3012). For example, a guidewire (notshown) may be configured to be slidably disposed within the lumen (3012)and/or other catheter (3010). In some variations, the dilator (3030) maydefine a recess (3040) configured to hold (e.g., surround, enclose) thebarb (3020). That is, the barb (3020) may be configured to be seatedwithin the recess (3040). For example, a length of the recess (3040) maybe at least equal to a length of the barb (3020) such that the entirebarb (3020) may fit within the recess (3040). In some variations, therecess (3040) may be defined within a proximal end of the dilator(3030).

FIG. 30A illustrates the ablation device (3000) in a first configurationwhere the barb (3020) is arranged inside the recess (3040) of thedilator (3030). In the first configuration, the barb (3020) may beprotected from contact with tissue which may be useful while thecatheter (3010) and dilator (3030) are advanced through the body of apatient. FIG. 30B illustrates the ablation device (3000) in a secondconfiguration where the barb (3020) is arranged outside the recess(3040) of the dilator (3030). In the second configuration, the barb(3020) may be configured to engage tissue as described in detail herein.

In some variations, a handle of the device may be configured to controltranslation of the barb (3020) and/or catheter (3010) relative to thedilator (3030), and therefore enable control of a size of the tissue tobe cut. For example, a barb (3020) extended from the dilator (3030) maytent engaged tissue and increase the diameter of tissue to be cut by theablation device (3000). In some variations, a position of a proximalportion of an ablation device (e.g., catheter comprising an electrode)and dilator (3030) may be fixed relative to the translatable barb(3020). For example, the barb (3020) may transition from the firstconfiguration to the second configuration after the dilator (3030) hasadvanced through the interatrial septum.

In some variations, the barb may be formed to have enough strength tohold tissue without breaking. The barb may comprise one or more ofstainless steel, nitinol, platinum, polyvinyl chloride (PVC),polyethylene (PE), cross-linked polyethylene, polyolefins, polyolefincopolymer (POC), polyethylene terephthalate (PET), polyester, nylon,polymer blends, polyester, polyimide, polyamides, polyurethane,silicone, polydimethylsiloxane (PDMS), PEBAX, combinations thereof, andthe like.

Additionally or alternatively, a barb may comprise one or more of aspiral, helical, corkscrew, and coil shape. FIG. 40A is a side view andFIG. 40B is a perspective view of a barb (4000) comprising adouble-helix shape. The barb (4000) may comprise a base (4010), a firstprojection (4020), and a second projection (4022). The projections(4020, 4022) may each comprise a distal tip configured to pierce (e.g.,penetrate) tissue. For example, the barb (4000) may be configured torotate (e.g., corkscrew) into tissue. The projections (4020, 4022) mayhave the same or different shape and dimensions. In some variations, acatheter may be configured to rotate about a longitudinal axis to enablethe barb (4000) to twist and engage tissue. As described in detailherein with respect to FIGS. 29A-29C, rotation of the barb may enablecontrol of a diameter of tissue to be cut.

In some variations, a barb may comprise set of concentric rings along alength of a second catheter. For example, the barb may comprise a set ofrings with a thin radial edge of each ring configured to engage tissue.The tented tissue engaged by the barb may be configured to form agenerally conical or cylindrical shape. In some variations, at least aportion of the barb may comprise a textured or roughened surfaceconfigured to aid tissue engagement. In other variations, the barb maycomprise a stepped structure. In some variations, the projection maycomprise a mesh comprised of one or more struts. For example, the meshmay be disposed radially about the second catheter and splay outward.

Visualization Features

In some variations, the ablation devices and systems described here maycomprise one or more visualization features for indirectly visualizingthe ablation device. For example, visualization features and techniquesmay facilitate one or more of imaging, positioning, alignment, andoperation of the ablation device in a body cavity. For example, indirectvisualization techniques may include, but are not limited to ultrasound,fluoroscopy, and X-ray. Fluoroscopically visualized elements, asdescribed in detail herein, enable alignment of catheters to tissue andeach other.

In some variations, a visualization feature may be visualized using atechnique such as ultrasound and fluoroscopy during operation of anablation system. For example, a contrast agent may be used to visualizeone or more components of an ablation device and their positions and/ororientations relative to tissue such as an interatrial septum. In somevariations, a contrast agent (e.g., contrast medium) may comprise one ormore of agitated saline and microbubbles (e.g., CO₂). In particular,microbubbles may be used in conjunction with sonographic (e.g.,ultrasound) examination such as an echocardiogram. For example,microbubbles may oscillate and vibrate when ultrasonic energy isreceived and reflect ultrasound waves. Microbubbles introduced into abody cavity may enhance a contrast of an image at the interface betweenthe tissue, blood, and ablation device.

In some variations, microbubbles may comprise a shell and a gas core.For example, a microbubble shell may comprise one or more of albumin,galactose, proteins, lipids, polymers, combinations thereof, and thelike. A microbubble gas core may comprise one or more of air, nitrogen,perfluorocarbons, combinations thereof, and the like.

Generally, microbubbles may comprise a diameter between about 1 μm andabout 1 mm, about 1 μm and about 5 μm, about 1 μm and about 10 μm, about10 μm and about 50 μm, about 50 μm and about 0.1 mm, about 0.1 mm andabout 0.5 mm, and about 0.5 mm and about 1 mm, including all ranges andsub-values in-between.

In some variations, the ablation devices described herein may beconfigured to output microbubbles for indirect visualization. FIG. 31Ais a side view of an ablation device (3100) comprising a first catheter(3110), electrode (3120), and dilator (3150). In some variations, thedilator (3150) may comprise one or more fluid ports (3160) configured tooutput a microbubble. That is, microbubbles may be introduced (e.g.,injected) into a body cavity when the ablation device (3100) is in aclosed configuration as described in detail herein. FIG. 31A illustratesa plurality of fluid ports (3160) arranged radially about a proximalcircumference of the dilator (3150). In some variations, microbubblesmay be delivered within a lumen of electrode (3120) and be configured toflow out of one or more of the fluid port (3160) to an exterior of theablation device (3100).

Additionally or alternatively, the electrode (3120) may comprise one ormore fluid ports, as discussed in more detail with respect to FIGS. 42Aand 42B. For example, a distal end of the electrode may comprise one ormore apertures (e.g., openings, slits, channels, recesses, ridges)configured to output a microbubble. In some variations, any portion ofthe electrode (3120) may comprise a fluid port (3160).

FIG. 31B is a cross-sectional side view of the ablation device (3100)comprising the first catheter (3110), electrode (3120), second catheter(3130), barb (3140), and dilator (3150). The ablation device (3100) inthe closed configuration shown in FIG. 31B depicts the barb (3140),microbubbles (3170), and proximal end of the dilator (3150) enclosedwithin a lumen of the electrode (3120). One or more of the firstcatheter (3110) and second catheter (3130) may be configured to output acontrast agent (3170) (e.g., microbubbles) from a respective contrastagent lumen (not shown in FIG. 31B). For example, the contrast agent(3170) may be output into a lumen of the electrode (3120) and then outof the ablation device (3100) via fluid port (3160).

In some variations, a contrast agent (e.g., microbubbles) may beintroduced (e.g., injected) into a lumen of the electrode (3120) andthen into a body cavity when the ablation device (3100) is in a closedconfiguration. FIG. 31C is a detailed cross-sectional side view of theablation device (3100). In some variations, the dilator (3152) maycomprise a mating surface (3152) configured to engage a distal end ofthe electrode (3120) in a closed configuration in a similar manner asdescribed with respect to, for example, FIGS. 6A-6C and 9A-9B. As shownin FIG. 31C, a contrast agent (3170) may be configured to flow betweenan inner diameter of the electrode (3120) and an outer diameter of aproximal end of the dilator (3150) and out of the fluid port (3160).Thus, the contrast agent (3170) may be output from the ablation device(3100) through the fluid port (3160). If the mating surface is notcompressed against the electrode (3120) (e.g., withdrawn by an operatorat a handle that applies a preload force), the ablation device (3100)may be configured to output microbubbles from the fluid port (3160).Thus, one or more fluid ports (3160) of the dilator (3150) may beconfigured to output a contrast agent (3170) received from a lumen ofthe electrode (3120).

FIGS. 31D, 31E, and 31F are perspective views of a distal portion of anablation device (3100) comprising the first catheter (3110), electrode(3120), second catheter (3130), barb (3140), and dilator (3150). Theablation device (3100) is disposed in an open configuration to aidillustration of various fluid port configurations (3160, 3162, 3164) ofthe dilator (3150). The fluid ports (3160, 3162, 3164) may be configuredto enable a contrast agent (e.g., microbubbles) to flow from a lumen ofthe electrode (3120) to an exterior of the ablation device (3100).Without fluid ports (3160, 3162, 3164), a contrast agent may be sealedwithin the lumen of the electrode (3120) while the ablation device(3100) is in the closed configuration, thus requiring the electrode(3120) to be separated from the dilator (3150). By contrast, the fluidports (3160) enable contrast agent flow into a body cavity from theclosed configuration.

In some variations, the fluid port (3160) may comprise a shapeincluding, but not limited to, an aperture, opening, slit, channel,recess, ridge, hole, recess, combinations thereof, and the like. FIG.31D illustrates a fluid port (3160) configuration comprising a pluralityof lengthwise channels disposed along a proximal portion of the dilator(3150) proximal to the mating surface (3152) of the dilator (3150). FIG.31E illustrates a fluid port (3162) configuration comprising a pluralityof recesses disposed within the mating surface (3152) of the dilator(3150). FIG. 31F illustrates a fluid port (3164) configurationcomprising a combination of the lengthwise channels of FIG. 31D andrecesses of FIG. 31E. In some variations, the ablation device (3100) maycomprise one or more fluid ports (3160). For example, the ablationdevice (3100) may comprise up to about 3 fluid ports, up to about 5fluid ports, up to about 7 fluid ports, up to about 10 fluid ports, upto about 20 fluid ports, up to about 50 fluid ports, up to about 75fluid ports, and up to about 100 fluid ports, including all values andsub-ranges in-between.

As shown in FIGS. 42A and 42B, an electrode (4200) may comprise one ormore fluid ports (4220). For example, a distal end (4210) of theelectrode (4200) may comprise one or more fluid ports (4220) (e.g.,apertures, openings, slits, channels, recesses, ridges, vents)configured to output a fluid (e.g., contrast agent, contrast medium,microbubble). For example, the fluid ports (4220) may comprise adiameter at least as large as a diameter of a microbubble to allowmicrobubbles to pass therethrough. In some variations, a fluid port ofan electrode (4200) may be aligned or offset from a fluid port of adilator. In some variations, the fluid ports described herein may beformed via laser cutting. In some variations, any portion of theelectrode (4200) may comprise a fluid port (4220).

FIG. 33A is a side view and FIG. 33B is a cross-sectional side view of adistal portion (3310) (e.g., dilator, distal tip) of an ablation device(3300). In some variations, a dilator (3310) may comprise a lumen(3312), a proximal end (3314), a mating surface (3316), and one or morevisualization features (3320, 3222). In some variations, a visualizationfeature (3320, 3222) may correspond to an echogenic region.

In some variations, the echogenic region may comprise one or moremicrospheres, recesses, protrusions, channels, grooves, scratches,edges, indentations, blind holes, hills-and-valleys, undercuts,combinations thereof, and the like. For example, one or moremicrospheres, recesses, or protrusions may comprise a diameter ofbetween about 5 μm and about 100 μm. In some variations, themicrospheres may comprise a gas core. The microspheres may compriseglass.

In some variations, the echogenic region may comprise one or moreportions of the dilator. For example, FIGS. 33A and 33B illustrate aproximal portion (3314) without visualization features (3320, 3222). Insome variations, the echogenic region may comprise a plurality oftexture patterns. For example, a first texture pattern may be arrangedalong a distal end of the dilator (3310) and a second texture patternmay be arranged along a proximal end of the dilator (3310). This may aididentification of different portions of the dilator (3310). In somevariations, a texture pattern may comprise a shape including, but notlimited to circumferential, radial, cross-hatched, random, linear,curved, spiral, ovoid, ellipsoid, sinusoidal, polygonal, non-linear,combinations thereof, and the like.

In some variations, the echogenic region may comprise a visualizationfeature (e.g., recess, protrusion, etc.) density of between about 5% andabout 50%, about 10% and about 40%, about 20% and about 30%, about 5%and about 10%, about 10% and about 20%, about 30% and about 40%, andabout 40% and about 50%, including all values and sub-ranges in-between.

In some variations, an echogenic region may be on and/or below a surfaceof the dilator (3310). For example, FIG. 33A depicts a schematic (e.g.,not to scale) representation of a plurality of microspheres formed ontop of a surface of the dilator (3310). In some variations, theechogenic region may comprise one or more surface textures or patternson the surface of the dilator (3310). In some variations, a surfacetexture of an echogenic region may be generated using one or more ofgrit blasting on an injection mold, laser engraving, abrasive finishing,grooving, etching, deposition, combinations thereof, and the like.

FIG. 33B depicts a schematic representation of a plurality ofmicrospheres formed beneath a surface of the dilator (3310). In somevariations, heat treatment (e.g., vesiculation) may be applied to thedilator (3310) to generate one or more microspheres beneath the surfaceof the dilator (3310). For example, heating the dilator (3310) above amelting temperature of a material (e.g., plastic) of the dilator (3310)may induce microbubble formation of void inclusions under a surface ofthe dilator through vaporization of volatile compounds. In somevariations, a dilator may be formed using microspheres such as glassbeads arranged beneath a surface of the dilator (3310). In somevariations, a high temperature heat source (e.g., flame, laser) maytreat a surface of the dilator (3310) in short bursts (e.g., sub-second)that may melt a surface but not through an entire thickness of thedilator (3310). Additionally or alternatively, a glass microsphere maybe compounded into a base resin material that is injection molded toform the dilator (3310).

Additionally or alternatively, fluoroscopy is a technique for real-timeX-ray imaging and may be used to guide catheter insertion and movementthrough blood vessels. Generally, in fluoroscopy, an X-ray beam isemitted from a fluoroscope through an area of interest in a body.Objects to be visualized (e.g., ablation device) may be imaged using animage intensifier. A user viewing the real-time images shown by theimage intensifier may then determine the orientation and alignment ofthe catheters relative to each other.

In some variations, one or more of the first and second catheters maycomprise a metal-based radiopaque marker comprising one or more of aring, band, and ink (e.g. platinum, platinum-iridium, gold, nitinol,palladium) configured to permit fluoroscopic visualization.

The ablation devices described herein may comprise any radiopaque metal,such as tungsten, platinum iridium, stainless steel, titanium, as wellas a tungsten filled polymer, zirconia ceramic, or any suitableradiopaque material. A visualization feature may be located at anysuitable position on or within the catheter (e.g., one or more exteriorsurfaces of the device, inside of the catheter, or the like). In somevariations, one or more portions of the ablation device may be made froma radiopaque material, or visualization feature may be attached to thedevice by any suitable method, for example, by mechanical attachment(e.g., embedded in a portion of the catheter, circumferentialcircumscription, or the like), adhesive bonding, welding, soldering,combinations thereof or the like.

Sensor

In some variations, the ablation devices and systems described here maycomprise one or more sensors. Generally, the sensors described here maybe configured to receive and/or transmit a signal corresponding to oneor more parameters. In some variations, the sensor may comprise one ormore of a pressure sensor, temperature sensor, electrical sensor (e.g.,impedance sensors, electrical voltage sensor for sensing signals such aselectromyogram, electrocardiogram, and the like), magnetic sensor (e.g.,RF coil), electromagnetic sensor (e.g., infrared photodiode, opticalphotodiode, RF antenna), force sensor (e.g., a strain gauge), flow orvelocity sensor (e.g., hot wire anemometer, vortex flowmeter),acceleration sensor (e.g., accelerometer), chemical sensor (e.g., pHsensors, protein sensor, glucose sensor), oxygen sensor (e.g., pulseoximetry sensor, myocardial oxygen consumption sensor), audio sensor(e.g., a microphone to detect heart murmurs, auscultation), sensor forsensing other physiological parameters (e.g., sensors to sense motion ofheart walls, heart rate, breathing rate, arrhythmia), a stimulator(e.g., for stimulation and/or pacing function), combinations thereof,and the like. In some variations, an impedance sensor may be configuredto monitor impedance between the electrode and return electrode toconfirm completion of tissue excision.

Guidewire

In some variations, a guidewire may be slidably disposed within anablation device and configured to cross the interatrial septum (e.g.,using a standard transseptal puncture technique). In some variations,first and second catheters of the ablation device may be translatedalong the guidewire relative to one another and/or the interatrialseptum. For example, the guidewire may comprise one or more of stainlesssteel, nitinol, platinum, and other suitable, biocompatible materials.

Catheter

Generally, the catheters described here may be configured to deliver anelectrode and barb to one or more heart chambers for cutting tissue suchas an interatrial septum. In some variations, a catheter may comprise ashaft composed of a flexible polymeric material such as Teflon, Nylon,Pebax, combinations thereof, and the like. In some variations, theablation device may comprise one or more steerable or deflectablecatheters (e.g., unidirectional, bidirectional, 4-way, omnidirectional).In some variations, the first catheter may comprise one or more pullwires configured to steer or deflect a portion of the first catheter. Insome variations, the first catheter may have a bend radius of betweenabout 45 degrees and about 270 degrees. In some variations, the secondcatheter described herein define a lumen through which a guidewire maypass.

In some variations, the catheter may be woven and/or braided andcomposed of a material (e.g., nylon, stainless steel, polymer)configured for catheter pushability and flexibility. In some variations,a first catheter may comprise a predetermined curved shape configured toguide a second catheter towards the septum at a predeterminedorientation and angle.

FIGS. 34A and 34B are cross-sectional side views of a distal end of afirst catheter (3410) of an ablation device (3400). In some variations,a distal portion of the first catheter (3410) may comprise apredetermined bend (e.g., precurve tip), as shown in FIG. 34A. Forexample, the predetermined bend may allow a distal end of the firstcatheter (3410) to be oriented at a predetermined angle to tissue suchas an interatrial septum. In some variations, the predetermined bend maycomprise an angle between about 30 degrees and about 70 degrees.

In some variations, the distal portion of the first catheter (3410) maybe positioned at a predetermined location and/or orientation (e.g.,substantially perpendicular to a tissue wall) by deflecting (e.g.,controlling a bend of) the first catheter (3410). In some variations,the first catheter actuator (3430) may be configured to deflect a distalportion of the first catheter (3410) while also electrically couplingthe electrode (3430) to a signal generator (not shown). In this manner,the first catheter actuator (3430) may simultaneously function as a pullwire configured to steer the first catheter (3410) and deliver energy tothe electrode (3420).

In some variations, the ablation device (3400) may comprise a firstcatheter (3410), an electrode (3420) coupled to a distal end of thefirst catheter (3410), and a first catheter actuator (3430) coupled tothe electrode (3420). For example, the first catheter actuator (3430)may be electrically coupled to the electrode (3420). In some variations,the first catheter actuator (3430) may be coupled (e.g., affixed,welded, laser welded) to an inner surface of the electrode (3420).Therefore, pulling on the first catheter actuator (3430) may allow apredetermined amount of tension to be applied to a distal portion of thefirst catheter (3410). A first catheter actuator (3430) may have alongitudinal axis that is offset and parallel with respect to a centrallongitudinal axis (not shown) of the first catheter (3410). Pulling onthe first catheter actuator (3430) may generate a bending moment betweena central longitudinal axis of the first catheter (3410) and the radiusto where the first catheter actuator (3430) is coupled to the electrode(3420).

The electrode (3420) may be configured to ablate tissue using electricalcurrent passed from the signal generator through an electrical conductor(e.g., lead wire) of the first catheter actuator (3430). In somevariations, the first catheter actuator (3430) may comprise a pull wireextending along a length of the first catheter (3410). A proximal end ofthe first catheter actuator (3430) may be configured to couple to anactuation mechanism. For example, a handle may comprise the actuationmechanism configured to steer the first catheter (3410) via the firstcatheter actuator (3430). That is, tension and/or compression may beapplied to the first catheter actuator (3430) in order to deflect (e.g.,change an angle) the distal portion of the first catheter (3410), asshown in FIG. 34B. Accordingly, a separate pull wire and lead wire isunnecessary such that the ablation device (3400) may be reduced in sizeand be less costly to manufacture.

FIGS. 34C and 34D are cross-sectional side views of variations of theablation device (3400). FIG. 34C illustrates an ablation device (3400)comprising a single first catheter actuator (3430) and FIG. 34Dillustrates an ablation device (3400) comprising a pair of firstcatheter actuators (3430, 3432). Each first catheter actuator (3430,3432) may be configured to electrically couple to an electrode forredundancy.

FIG. 34C depicts an ablation device (3400) comprising a first catheter(3410) defining a first catheter lumen (3412) and a first catheteractuator lumen (3434). In some variations, the first catheter actuator(3430) may comprise a lead wire (3431) comprising an insulatorsurrounding an electrode wire. In some variations, the insulator may beconfigured as a slidable channel. The insulator may comprise, forexample, PTFE, PEEK, polyimide, combinations thereof, and the like. Insome variations, the first catheter actuators (3430, 3432) may becoupled to an inner wall of the first catheter (3410) along a length ofthe first catheter (3410).

In some variations, a plurality of first catheter actuators may furtheraid steerability and enhance control of an ablation device. For example,the first catheter actuators may be actuated together to provide a pushand pull action (e.g., one actuator configured to pull while anotheractuator pushes). FIG. 34D depicts an ablation device (3400) comprisinga first catheter (3410) defining first catheter actuator lumens (3434,3436) having respective first catheter actuators (3430, 3432). In somevariations, the first catheter actuators (3430, 3432) may be disposed onopposite side of the first catheter (3410). In some variations, thefirst catheter actuator lumens (3434, 3436) may comprise a “D” shape.

In some variations, a first catheter actuator may be composed ofstainless steel. In some variations, a first catheter (3410) maycomprise a core (3411) (e.g., PTFE) configured to maintain an alignmentand radial position of the first catheter actuator(s) (3430, 3432).

Dilator

Generally, the dilators described here may be configured to puncturetissue such as an interatrial septum to allow one or more portions of anablation device to be advanced into a body cavity such as a left atriumof the heart. In some variations, a dilator may generally be configuredto dilate tissue such as an interatrial septum. The dilator may beatraumatic in profile to minimize any inadvertent or unintended damage.The dilator may comprise a taper of between about 1 degree and about 45degrees to facilitate device crossing of the septum to the left atrium.In some variations, the dilator may comprise a thermoplastic polymer,nylon, polyurethane, ABS, acetal, polycarbonate, PET, PEBA, PEEK, PTFE,silicone, PS, PEI, latex, sulphate, barium sulfate, a copolymer,combinations thereof, and the like. As described in more detail herein,a dilator may comprise one or more visualization features such as afluid port and echogenic region.

In some variations, a dilator of an ablation device may be configured toaid a tissue compression and/or cutting process. As described herein, adistal end of an electrode may be configured to abut against acorresponding mating surface of a dilator. For example, a secondcatheter may be withdrawn with respect to a first catheter such that amating surface applies a preload force to an electrode. Compression ofthe tissue between the electrode and mating surface (via the preloadforce) may reduce the thickness of the tissue to be cut such that aseptum may be cut more quickly and with less energy. Furthermore,compressed tissue may hold (e.g., secure, lock) the tissue in placerelative to the ablation device to ensure that only a predeterminedportion of tissue is cut. In some variations, compression of the tissuewhile electrical energy is applied may fuse layers of tissue (e.g., leftand right atrial septal layers) together during ablation, therebyreducing a surface area of exposed tissue along a perimeter of theanastomosis after tissue excision. Compression of tissue may also reducea volume of tissue.

In some variations, the dilator may be configured to contact andelectrically short the electrode when tissue is fully cut. This may haltthe formation of cutting plasma and reduce excess energy delivery, heat,bubble formation, neurostimulation, and the like. For example, when anuninsulated distal end of an electrode is energized, cutting plasma maybe generated to excise tissue compressed between the electrode and amating surface of the dilator. However, once the tissue is cut andseparated from the electrode, the electrode may be isolated from theconductive pathway of the body provided by the tissue, therebyextinguishing the cutting plasma. Thus, completion of tissue ablationmay be performed mechanically without sensors and/or feedback control,thereby reducing complexity of an ablation procedure.

FIG. 35A is a cross-sectional side view of a distal end of an ablationdevice (3500) comprising a dilator (3510), insulator (3520), andelectrode (3530). The dilator (3510) may comprise a lumen (3512), aproximal end (3514), and a mating surface (3516) that defines a recess(3518) configured to receive a distal end of the electrode (3530). Asshown in FIG. 35A, the distal end of the electrode (3530) isuninsulated. In some variations, the mating surface (3518) may compriseone or more of a non-conductive and/or thermally resistant portion. Insome variations, the mating surface (3518) may be configured towithstand high temperatures generated during an ablation procedure. Forexample, the non-conductive portion may comprise one or more of apolymer (e.g., PEEK, polyimide), ceramic (e.g., zirconia), and aluminumoxide. Therefore, the electrode (3530) may be configured to electricallyshort when the electrode (3530) cuts tissue and engages the recess(3518) of the mating surface (3516).

Additionally or alternatively, the mating surface may comprise adeformable material. FIG. 35B is a detailed cross-sectional side view ofan ablation device (3550) including a dilator (3560), insulator (3570),and electrode (3580). The dilator (3560) may comprise a proximal end(3564) and a mating surface (3566). In some variations, the matingsurface (3516) may be configured to be deformable (e.g., compressible).As the dilator (3560) is withdrawn towards the electrode (3580), tissuedisposed between the electrode (3580) and mating surface (3566) may becompressed along with the mating surface itself.

Additionally or alternatively, the mating surface may comprise aconductive portion configured to focus RF energy (e.g., focusedmonopolar) in order to function as a dissipation element and/or enhanceelectric field lines and thus control stray excitation of tissue duringcutting. For example, the conductive portion of the dilator may increasethe surface area electrically coupled to the electrode in order toreduce a current density of the electrode below a threshold levelsufficient to cut tissue. Thus, the electrode may be configured tocontact the conductive mating surface after the tissue is cut. In somevariations, the conductive portion of the mating surface may have asurface area between about 4 times and about 10 times the surface areaof an exposed portion of the electrode (e.g., distal edge of theelectrode).

In some variations, the dilator may comprise a length of between about 2mm and about 2 cm. For example, the dilator may comprise a length ofbetween about 5 mm and about 1 cm. In some variations, the dilator maycomprise a taper of between about 5 degrees and about 20 degreesrelative to a longitudinal axis of the dilator. In some variations, adistal end of the dilator may be atraumatic (e.g., rounded, blunted). Asdescribed herein, a barb may be coupled to the proximal end of thedilator.

Handle

Generally, the handles described here may be configured to allow anoperator to grasp and control one or more of the position, orientation,and operation of an ablation device. In some variations, a handle maycomprise an actuator to permit translation and/or rotation of the firstand second catheters in addition to steering by an optional deliverycatheter. Deployment of a barb, in some variations, may be performed bya deployment mechanism (e.g., screw/rotation mechanism, translationmechanism, slider). In some variations, the handle may be configured tolimit the applied force that a user may administer to the advancementand retraction of the catheter shafts relative to each other. Forexample, the handle may be configured to apply energy to the electrodeto ablate tissue and/or control one or more sensors. In some variations,the handle may be coupled between a signal generator and an ablationdevice.

FIG. 39A is a perspective view and FIG. 39B is a plan view of a handle(3900) of an ablation device. In some variations, the handle (3900) maycomprise one or more actuation mechanisms (3910), fluid ports (3920),and detachable electrical connector (3930). The handle (3900) may becoupled to a proximal end of a first catheter (3950). In somevariations, the handle (3900) may be configured to be held (e.g.,grasped) by an operator and enable control of one or more of catheterdeflection (e.g., steerability), tissue ablation (e.g., electrode energydelivery), catheter translation (e.g., transition between open andclosed configuration, tissue compression), and visualization (e.g.,contrast fluid delivery).

For example, actuation mechanism (3910) may be configured to control apreload force, as described in detail herein, of a dilator of a secondcatheter applied against an electrode of the first catheter. In somevariations, the actuation mechanism (3910) may comprise a screwmechanism having a plurality of predetermined stops that enable anoperator to select an amount of preload at a distal end of the ablationdevice. For example, an operator may select a predetermined preloadforce using the actuation mechanism (3910) when the ablation device isin a cutting configuration where tissue is compressed between anelectrode and a dilator. In some variations, the actuation mechanism(3910) may be coupled to a shaft of a second catheter such that theactuation mechanism (3910) may be configured to pull a distal portion ofthe second catheter towards the handle (3900) using the screw mechanism.

In some variations, an actuation mechanism (3910) may be configured toactuate one or more first catheter actuators as described herein. Forexample, the first catheter actuators may be configured to steer and/ordeflect a distal portion of the first catheter. That is, the actuationmechanism (3910) may be configured to push and/or pull on the firstcatheter.

Signal Generator

Generally, the signal generators described here may be configured toprovide energy (e.g., energy waveforms) to an ablation device to ablatepredetermined portions of tissue such as an interatrial septum. In somevariations, an ablation system as described herein may include a signalgenerator having an energy source and a processor configured to delivera waveform to deliver energy to tissue (e.g., interatrial septum). Thewaveforms disclosed herein may aid in forming an anastomosis. In somevariations, the signal generator may be configured to control waveformgeneration and delivery in response to received sensor data. Forexample, energy delivery may be inhibited unless a pressure sensormeasurement confirms tissue engagement and compression between anelectrode and corresponding mating surface.

The signal generator may generate and deliver several types of signalsincluding, but not limited to, radiofrequency (RF), direct current (DC)impulses, stimulus range impulses, and/or hybrid electrical impulses.For example, the signal generator may generate monophasic (DC) pulsesand biphasic (DC and AC) pulses. The signal generator may comprise aprocessor, memory, energy source, and user interface. The processor mayincorporate data received from one or more of memory, energy source,user interface, ablation device. The memory may further storeinstructions to cause the processor to execute modules, processes and/orfunctions associated with the system, such as waveform generation anddelivery. For example, the memory may be configured to store patientdata, clinical data, procedure data, and the like.

In some variations, the signal generator may be configured to generatealternating current, voltage, and/or power in the radiofrequencyspectrum between about 9 kHz and about 300 MHz at a power level betweenabout 5 W and about 500 W. In some variations, the RF generator isoperated by outputting constant voltage, constant power, and/or constantcurrent. In some variations, the RF generator outputs a constant sinewave throughout the duration of tissue cutting. For example, the RFgenerator may be configured to output a sine wave between about 400 kHzand about 600 kHz, between about 450 kHz and about 550 kHz, and betweenabout 475 kHz and about 525 kHz, including all values and sub-rangesin-between. In some variations, the RF signal output is interrupted anddampened such that RF energy is applied for a fixed percentage ofoperation time.

In some variations, the signal generator may be configured tosynchronize energy delivery with a predetermined phase of a patient'scardiac cycle. For example, a sensor may be configured to measure an ECGsignal and the signal generator may be configured to deliver a signalwaveform based on (e.g., in synchronicity) with the ECG signal.Additionally or alternatively, a pacing signal for cardiac stimulationmay be generated and used to deliver a signal waveform by the signalgenerator in synchronization with the pacing signal.

FIG. 37 is a voltage waveform (3700) of an illustrative variation of anablation procedure comprising a first waveform (e.g., overshoot spike)(3710) and a second waveform (e.g., substantially steady-state voltage)(3720). In some variations, a signal generator may be configured togenerate a first waveform (3710) followed by a second waveform (3720)where the first waveform comprise a first voltage higher than a secondvoltage of the second waveform. The first waveform (3710) may beconfigured to cut tissue quickly upon energy delivery. The secondwaveform (3720) having a lower voltage may reduce one or more of thermalspread, bubbling, neurostimulation, and the like. The second waveformmay be configured to desiccate the cut tissue held within the ablationdevice, thereby aiding containment and compartmentalization of tissue.

Alternatively, the first waveform may be configured to desiccate thetissue. For example, the first waveform may comprise a voltage below anionization threshold of vapor (e.g., below about 130 volts) for aduration of between about 100 msec and about 60 seconds. Impedance maybe monitored to prevent plasma formation.

Generally, the processor (e.g., CPU) described here may process dataand/or other signals to control one or more components of the system.The processor may be configured to receive, process, compile, compute,store, access, read, write, and/or transmit data and/or other signals.In some variations, the processor may be configured to access or receivedata and/or other signals from one or more of a sensor (e.g., pressuresensor) and a storage medium (e.g., memory, flash drive, memory card).In some variations, the processor may be any suitable processing deviceconfigured to run and/or execute a set of instructions or code and mayinclude one or more data processors, image processors, graphicsprocessing units (GPU), physics processing units, digital signalprocessors (DSP), analog signal processors, mixed-signal processors,machine learning processors, deep learning processors, finite statemachines (FSM), compression processors (e.g., data compression to reducedata rate and/or memory requirements), encryption processors (e.g., forsecure wireless data and/or power transfer), and/or central processingunits (CPU). The processor may be, for example, a general purposeprocessor, Field Programmable Gate Array (FPGA), an Application SpecificIntegrated Circuit (ASIC), a processor board, and/or the like. Theprocessor may be configured to run and/or execute application processesand/or other modules, processes and/or functions associated with thesystem. The underlying device technologies may be provided in a varietyof component types (e.g., metal-oxide semiconductor field-effecttransistor (MOSFET) technologies like complementary metal-oxidesemiconductor (CMOS), bipolar technologies like emitter-coupled logic(ECL), polymer technologies (e.g., silicon-conjugated polymer andmetal-conjugated polymer-metal structures), mixed analog and digital,and/or the like.

The systems, devices, and/or methods described herein may be performedby software (executed on hardware), hardware, or a combination thereof.Hardware modules may include, for example, a general-purpose processor(or microprocessor or microcontroller), a field programmable gate array(FPGA), and/or an application specific integrated circuit (ASIC).Software modules (executed on hardware) may be expressed in a variety ofsoftware languages (e.g., computer code), including C, C++, Java®,Python, Ruby, Visual Basic®, and/or other object-oriented, procedural,or other programming language and development tools. Examples ofcomputer code include, but are not limited to, micro-code ormicro-instructions, machine instructions, such as produced by acompiler, code used to produce a web service, and files containinghigher-level instructions that are executed by a computer using aninterpreter. Additional examples of computer code include, but are notlimited to, control signals, encrypted code, and compressed code.

Generally, the ablation device described here may comprise a memoryconfigured to store data and/or information. In some variations, thememory may comprise one or more of a random access memory (RAM), staticRAM (SRAM), dynamic RAM (DRAM), a memory buffer, an erasableprogrammable read-only memory (EPROM), an electrically erasableread-only memory (EEPROM), a read-only memory (ROM), flash memory,volatile memory, non-volatile memory, combinations thereof, and thelike. In some variations, the memory may store instructions to cause theprocessor to execute modules, processes, and/or functions associatedwith a ablation device, such as signal waveform generation, ablationdevice control, data and/or signal transmission, data and/or signalreception, and/or communication. Some variations described herein mayrelate to a computer storage product with a non-transitorycomputer-readable medium (also may be referred to as a non-transitoryprocessor-readable medium) having instructions or computer code thereonfor performing various computer-implemented operations. Thecomputer-readable medium (or processor-readable medium) isnon-transitory in the sense that it does not include transitorypropagating signals per se (e.g., a propagating electromagnetic wavecarrying information on a transmission medium such as space or a cable).The media and computer code (also may be referred to as code oralgorithm) may be those designed and constructed for the specificpurpose or purposes.

In some variations, the ablation device may further comprise acommunication device configured to permit an operator to control one ormore of the devices of the ablation system. The communication device maycomprise a network interface configured to connect the ablation deviceto another system (e.g., Internet, remote server, database) by wired orwireless connection. In some variations, the ablation device may be incommunication with other devices (e.g., cell phone, tablet, computer,smart watch, and the like) via one or more wired and/or wirelessnetworks. In some variations, the network interface may comprise one ormore of a radiofrequency receiver/transmitter, an optical (e.g.,infrared) receiver/transmitter, and the like, configured to communicatewith one or more devices and/or networks. The network interface maycommunicate by wires and/or wirelessly with one or more of the ablationdevice, network, database, and server.

The network interface may comprise RF circuitry configured to receiveand/or transmit RF signals. The RF circuitry may convert electricalsignals to/from electromagnetic signals and communicate withcommunications networks and other communications devices via theelectromagnetic signals. The RF circuitry may comprise well-knowncircuitry for performing these functions, including but not limited toan antenna system, an RF transceiver, one or more amplifiers, a tuner,one or more oscillators, a mixer, a digital signal processor, a CODECchipset, a subscriber identity module (SIM) card, memory, and so forth.

Wireless communication through any of the devices may use any ofplurality of communication standards, protocols and technologies,including but not limited to, Global System for Mobile Communications(GSM), Enhanced Data GSM Environment (EDGE), high-speed downlink packetaccess (HSDPA), high-speed uplink packet access (HSUPA), Evolution,Data-Only (EV-DO), HSPA, HSPA+, Dual-Cell HSPA (DC-HSPDA), long termevolution (LTE), near field communication (NFC), wideband code divisionmultiple access (W-CDMA), code division multiple access (CDMA), timedivision multiple access (TDMA), Bluetooth, Wireless Fidelity (WiFi)(e.g., IEEE 802.11a, IEEE 802.11b, IEEE 802.11g, IEEE 802.11n, and thelike), voice over Internet Protocol (VoIP), Wi-MAX, a protocol fore-mail (e.g., Internet message access protocol (IMAP) and/or post officeprotocol (POP)), instant messaging (e.g., extensible messaging andpresence protocol (XMPP), Session Initiation Protocol for InstantMessaging and Presence Leveraging Extensions (SIMPLE), Instant Messagingand Presence Service (IMPS)), and/or Short Message Service (SMS), or anyother suitable communication protocol. In some variations, the devicesherein may directly communicate with each other without transmittingdata through a network (e.g., through NFC, Bluetooth, WiFi, RFID, andthe like).

In some variations, the user interface may comprise an input device(e.g., touch screen) and output device (e.g., display device) and beconfigured to receive input data from one or more of the ablationdevice, network, database, and server. For example, operator control ofan input device (e.g., keyboard, buttons, touch screen) may be receivedby the user interface and may then be processed by processor and memoryfor the user interface to output a control signal to the ablationdevice. Some variations of an input device may comprise at least oneswitch configured to generate a control signal. For example, an inputdevice may comprise a touch surface for an operator to provide input(e.g., finger contact to the touch surface) corresponding to a controlsignal. An input device comprising a touch surface may be configured todetect contact and movement on the touch surface using any of aplurality of touch sensitivity technologies including capacitive,resistive, infrared, optical imaging, dispersive signal, acoustic pulserecognition, and surface acoustic wave technologies. In variations of aninput device comprising at least one switch, a switch may comprise, forexample, at least one of a button (e.g., hard key, soft key), touchsurface, keyboard, analog stick (e.g., joystick), directional pad,mouse, trackball, jog dial, step switch, rocker switch, pointer device(e.g., stylus), motion sensor, image sensor, and microphone. A motionsensor may receive operator movement data from an optical sensor andclassify an operator gesture as a control signal. A microphone mayreceive audio data and recognize an operator voice as a control signal.

A haptic device may be incorporated into one or more of the input andoutput devices to provide additional sensory output (e.g., forcefeedback) to the operator. For example, a haptic device may generate atactile response (e.g., vibration) to confirm operator input to an inputdevice (e.g., touch surface). As another example, haptic feedback maynotify that operator input is overridden by the ablation device.

II. Methods

Also described here are methods of forming an anastomosis in aninteratrial septum of a patient using the systems and devices describedherein. In particular, the systems, devices, and methods describedherein may be used to capture, excise, and remove a predeterminedportion of tissue to create an anastomosis for treating heart failure.In some variations, a method of forming an anastomosis may includeadvancing a device into a right atrium of a patient. A guidewire may beadvanced across an interatrial septum of the heart and into a leftatrium. The device may comprise a dilator configured to puncture theseptum such that a first catheter is disposed within the right atriumand a second catheter is disposed in the left atrium. The secondcatheter may comprise a barb configured to engage and secure tissue whenwithdrawn relative to the first catheter. As the barb is furtherwithdrawn (e.g., towards the right atrium), the engaged tissue maystretch and/or compress against the barb and form a “tent” shape due tothe elasticity of the tissue. The barb and the engaged tented tissue maybe withdrawn into a lumen of the electrode (e.g., tubular electrode). Bypositioning the ablation device across both sides of the interatrialseptum, a predetermined force may be applied to engage and/or compress apredetermined portion of septum tissue to be ablated. For example, theelectrode of the first catheter may compress septum tissue against aproximal end (e.g., mating surface) of the dilator. The electrodedisposed in the right atrium may be energized to cut (e.g., excise)tissue using RF energy using an ablation waveform as described in moredetail herein. The excised tissue may be enclosed by the ablation deviceto prevent tissue loss. For example, excised tissue may be held by thebarb and the electrode may surround the excised tissue and barb.Accordingly, the ablation devices described herein may be configured toform an interatrial anastomosis safely and efficiently.

FIG. 18 is a flowchart that generally describes a variation of a methodof forming an anastomosis (1800). The method (1800) may includeadvancing an ablation device comprising a first catheter and a secondcatheter into a right atrium of a patient (1802). For example, theablation device may be advanced over a guidewire and inserted throughthe femoral vein using, for example, a transseptal puncture method. Insome variations, the ablation device within the right atrium may beoriented approximately perpendicular to an interatrial septum. Forexample, a first catheter actuator as described herein may be configuredto deflect a distal portion of the ablation device to reposition theablation device relative to the interatrial septum. The first cathetermay abut the second catheter when advanced into the heart. For example,a delivery catheter may be configured to hold each of the first catheterand the second catheter until deployment in the heart.

The ablation device catheters may be indirectly visualized as necessarythroughout an ablation procedure. Indirect visualization, such asechocardiography and/or fluoroscopy, may assist an operator inpositioning and/or aligning the ablation device relative to tissue. Forexample, under ultrasound imaging, a contrast agent such as microbubblesmay be introduced into an endocardial space using the ablation device inorder to position an electrode and/or dilator relative to an interatrialseptum disposed therebetween. A user may then bring the catheters intoclose approximation to compress and cut the tissue. In some variations,the ablation device may be configured to output microbubbles in a closedconfiguration for ultrasonic visualization of the ablation device andinteratrial septum.

In some variations, a contrast agent may be introduced into the heartvia a fluid port in the dilator. In some of these variations, a contrastagent may be introduced into a lumen of the electrode. Additionally oralternatively, a distal end of the ablation device may comprise anechogenic region may receive ultrasound waves. For example, the distalend of the ablation device may comprise one or more microspherescomprising a diameter of between about 5 μm and about 100 μm.

FIG. 32 is a side view of an ablation device (3200) in an endocardialspace. In some variations, ablation device (3200) may comprise a firstcatheter (3210), an electrode (3220), second catheter (3230), barb(3240), and dilator (3250). The ablation device (3200) is depicted in anopen configuration with tissue (e.g., interatrial septum) (3280)disposed between the electrode (3220) spaced apart from the barb (3240)and dilator (3250). In some variations, the first catheter (3120) may beconfigured to output a contrast agent (e.g., microbubbles) (3270) into alumen of the electrode (3220) and endocardial space. For example, acontrast agent lumen (3212) of the first catheter (3210) may beconfigured to output a contrast agent (3270) into a lumen of theelectrode (3220). Contact between the contrast agent (3270) and theelectrode (3220) and tissue (3280) may enable indirect visualization(e.g., echocardiography) of one or more steps of an ablation procedure.Visualization of the ablation device (3200) and tissue (3280) may aidpositioning of the electrode with respect to the tissue (3280). Forexample, contrast agent (3270) may be introduced into a right atriumprior to engaging the tissue (3280) using the barb. The contrast agent(3270) flowing through the lumen of the electrode (3220) and theendocardial space may allow visualization of the electrode (3220) andthe right atrium side of the interatrial septum.

The second catheter may be advanced into a left atrium through theinteratrial septum (1804). For example, a dilator of the second cathetermay be advanced (e.g., over a guidewire) across the interatrial septumsuch that the guidewire and dilator are located in the left atrium. Thesecond catheter may be translated relative to the first catheter. A barbof the second catheter may be advanced into the left atrium such thatthe electrode of the first device may be located in the right atrium.Septum tissue may slide over the barb as it is advanced into the leftatrium. As shown in FIGS. 19A and 19B, an ablation device (1900) may bedisposed within a right atrium (1990) and advanced into a left atrium(1980) using a dilator of a second catheter (1950). The second catheter(1950) may be translated relative to a first catheter (1910) in theright atrium (1990) and the interatrial septum (1970). The barb (1940)of the second catheter (1950) may be advanced through the septum (1970)and into the left atrium (1980). As shown in the cross-sectional sideview of FIG. 19C, the first catheter (1910) may comprise a tubularelectrode (1920), a lumen (1922), a lead (1924), connector (1926), andinsulator (1960). The second catheter (1950) may comprise a barb (1940),mating surface (1954), dilator, and dilator lumen (1952).

In some variations, the ablation device may introduce a contrast agent(e.g., microbubbles) for visualization an interface between the dilator,tissue, and electrode. In some variations, the electrode may berepositioned between about 2 mm and about 5 mm away from the interatrialseptum based on the visualization.

The second catheter may be withdrawn relative to the first catheter(1806). For example, the second catheter may be translated toward thefirst catheter to bring the electrode and dilator closer together. Insome variations, the second catheter may be withdrawn while the firstcatheter is held in a substantially fixed position in the right atrium.In some variations, a contrast agent (e.g., microbubbles) may beintroduced to confirm a position of the barb, tissue, and electrode.

In some variations, withdrawing the second catheter towards the firstcatheter may comprise translating the barb relative to the dilator toengage the first portion of the septum. For example, the barb may bewithdrawn away from the dilator as shown in FIGS. 30A and 30B. Inparticular, the first catheter (3030) may transition from a firstconfiguration where the barb (3020) is arranged inside a recess (3040)of the dilator (3030) to a second configuration where the barb (3020) isarranged outside the recess (3040).

As the second catheter is withdrawn, the barb of the second catheter mayengage a predetermined portion of the septum (1808). In some variations,as shown in FIGS. 29A-29C, may comprise rotating the barb about alongitudinal axis of the barb. A size of a first tissue portion cut froma second tissue portion may correspond to a rotation angle of the barb.The barb may be rotated at a rotation angle of up to about 360 degrees.

As shown in FIG. 19D, as the second catheter (1950) is withdrawnrelative to the first catheter (1910), the barb (1940) may engage septumtissue (1970). For example, the barb may pierce through the firstportion when withdrawing the second catheter towards the first catheter.The barb may pierce through the first portion such that the layers of aninteratrial septum (e.g., left and right atrium layers) are heldtogether to reduce tissue separation and/or tissue shearing.Accordingly, the barb (1940) may capture (e.g., secure, hold) tissue(1970) while maintaining the structural integrity of the septum. In somevariations, the withdrawn barb may apply a force to the septum to holdand stretch the portion (e.g., first portion) of the septum over thebarb. The force may increase as the second catheter is withdrawn furthertowards the first catheter. In some variations, withdrawal of the secondcatheter may apply a force of at least 20 grams to the interatrialseptum. For example, the ablation device may apply a force of betweenabout 20 grams and about 30 grams to the interatrial septum. In somevariations, the first portion of the septum may form a substantiallycylindrical shape when withdrawn into the lumen.

The barbs described herein have a configuration designed to engage thefirst portion of the septum without shearing the tissue (e.g., breakingor tearing through one or more layers of the interatrial septum) suchthat the first portion remains intact when engaged to the barb andwithdrawn into the lumen of the electrode. That is, the forces appliedby the barbs described herein allow the structural integrity of thefirst portion to be maintained even when the barb pierces through theseptum. This may ensure that the first portion of the septum to beexcised remains held and secured by the barb throughout the procedure,thereby improving the consistency and safety of the methods describedherein.

The septum may be withdrawn into a lumen of an electrode (1810). In somevariations, a portion of the interatrial septum may form a tent over thebarb as the septum is withdrawn into the lumen of the electrode. In thismanner, tissue to be cut may be secured within the ablation device priorto excision to reduce the risk of uncontrolled tissue loss in the heartchambers and vasculature. As shown in FIG. 19E, a portion of the septum(1970) may form a tent-like shape over the barb (1940). In somevariations, the barb (1970) engaged to tissue may rotate as it iswithdrawn into the lumen of the electrode to apply a rotational force tothe stretched (e.g., tented) septum tissue. In some variations, a size(e.g., diameter) of the tissue (1970) to be cut may be controlled byvarying a distance that the engaged tissue (1970) is withdrawn into thelumen (1922). Therefore, a size of an anastomosis may be independent ofthe electrode diameter. By withdrawing the second catheter towards thefirst catheter, the ablation device (1900) engages, stretches,compresses, locks, and tents the tissue, as well as controls a size ofthe opening to be cut. In some variations, the size of an anastomosismay depend on the distance the barb is withdrawn into the electrode suchthat a size of an anastomosis may be independent of the diameter of theablation device.

In some variations, a contrast agent (e.g., microbubbles) may beintroduced to confirm a position of the barb, tissue, and electrode(e.g., confirm that the electrode is in the right atrium).

The septum may be compressed (1812) between the electrode and dilator.As shown in FIG. 19E, a portion of the interatrial septum (1970) may beheld between the electrode (1920) and the dilator (1950). For example,the electrode and the dilator may be brought together to abut (e.g.,compress) opposite sides of the interatrial septum (1970) to “lock” thetissue (1970) in place relative to the ablation device (1900). In somevariations, the force applied to the interatrial septum by the barb(1940) and through compression may be applied prior to and duringdelivery of the ablation waveform. The compressed tissue may allow areduction in applied RF energy necessary to cut the tissue. In somevariations, one or more of the barb and dilator may be rotated about alongitudinal axis of the second catheter to further engage and/orcompress tissue.

In some variations, as shown in FIG. 35B, withdrawing the secondcatheter towards the first catheter may deform a compressible proximalportion of the dilator.

FIG. 36A is a side view of an ablation device (3600) in an endocardialspace illustrating compression step of an ablation procedure. In somevariations, the ablation device (3600) may comprise a first catheter(3610), an electrode (3620), second catheter (3630), barb (3640), anddilator (3650). In some variations, the first catheter (3610) maycomprise a contrast agent lumen (3612) as described in more detailherein. In some variations, the electrode (3620) may comprise a lumenconfigured to hold one or more of the barb (3640), a first portion(3672) of tissue, and a proximal portion (3652) of the dilator (3650).In some variations, a guidewire (3630) may be slidably disposed withinthe second catheter (3630).

As depicted in FIG. 36A, the barb (3640) may be configured to engage afirst portion (3672) of the interatrial septum (3670) in a cuttingconfiguration where the tissue (3674) is compressed between a distaledge of the electrode (3630) and the proximal portion (3652) of thedilator (3650). For example, a distal end of an electrode (3620) may beconfigured to abut against a corresponding mating surface (3652) of thedilator (3650). For example, the second catheter (3630) may be withdrawnwith respect to the first catheter (3610) such that a mating surface(3652) applies a preload force to the tissue (3674) and electrode(3620). In some variations, application of the preload force may becontrolled by an operator via an actuator of a handle. Compression ofthe tissue between the electrode and mating surface (via the preloadforce) may reduce the thickness of the tissue to be cut such that aseptum may be cut faster and with less energy. Furthermore, compressedtissue may hold (e.g., secure, lock) the tissue in place relative to theablation device to ensure that only a predetermined portion of tissue iscut. Compression of tissue may also reduce a volume of tissue. In somevariations, a preload force may be between about 0.4 N to about 25 N,about 1 N to about 10 N, about 5 N to about 10 N, about 5 N to about 15N, about 10 N to about 20 N, including all ranges and sub-valuesin-between.

In some variations, the compressed tissue (3674) and the dilator (3650)may come to rest in a static equilibrium state where the proximalportion (3652) of the dilator (3650) compresses the tissue (3674)against the electrode (3620) with a shear force comprising a radialcomponent. In some variations, extension of the dilator (3650) prior tocutting is beneficial to the operator when viewed fluoroscopically. Insome variations, the ablation device (3600) in the cutting configuration(FIG. 36A) may correspond to a dilator (3650) being extended about 1 mmaway from an end of the electrode (3620).

An ablation waveform may be delivered to the electrode to cut the septum(1814). For example, a signal generator may generate a biphasicradiofrequency waveform configured to ablate a portion of theinteratrial septum held by the device. In some variations, the electrodemay be configured to transmit 50 mA to 4 A of current between about 0.1kV and about 4.0 kV at a rate of up to about 500 kHz.

In some variations, delivery of the ablation waveform may be controlledbased on a distance between the electrode and the dilator. For example,the electrode may be configured to electrically short when the electrodecontacts the mating surface of the dilator during delivery of theablation waveform.

In some variations, the ablation waveform may comprise a first waveformfollowed by a second waveform. The first waveform may comprise a firstvoltage and the second waveform may comprise a second voltage. The firstvoltage may be higher than the second voltage.

FIG. 19F illustrates the interatrial septum (1970) defining thepredetermined opening and the ablation device (1900) holding the excisedtissue by the barb (1940) within the lumen (1922) of the electrode(1920). As shown in FIG. 19F, the septum (1970) may snap back afterexcising the tissue engaged by the barb (1940). The tissue within thelumen (1922) may be sealed within the ablation device (1900) onceablation is completed and the electrode contacts the dilator (1950). Inthis manner, excised tissue may be prevented from being lost in thebody.

FIG. 36B depicts the ablation device (3600) in a closed (e.g., seated)configuration with cut tissue (e.g., first portion) (3672) engaged tothe barb (3640) and held within a lumen of the electrode (3620). Theproximal portion (3652) of the dilator (3650) may be, for example,seated within the lumen of the electrode (3620). FIG. 36B depicts a hole(3676) formed in the interatrial septum (3670).

In some variations, visualization may confirm the completion of anenergy delivery process. For example, the differences between theablation device (3600) in the cutting configuration (FIG. 36A) and theclosed configuration (FIG. 36B) may be confirmed through indirectvisualization. For example, fluoroscopic visualization may confirm whentissue is interposed between the electrode (3620) and dilator (3650) andwhen tissue has been cut after energy delivery based on an imagedposition of the dilator (3650) relative to the electrode (3620).

In some variations, a preload force (e.g., first predetermined force)may be applied by the dilator (3650) to the electrode (3620) duringand/or after energy delivery to ensure withdrawal of the second catheter(3630) towards the first catheter (3610). In some variations, anoperator may activate a switch in a handle to initiate energy deliveryto cut tissue. As the proximal portion (3652) withdraws toward andcompresses against the electrode (3620) during energy delivery, theproximal portion (3652) may shear (e.g., cut, separate) the tissue fromthe septum (3670) with a second predetermined force greater than thefirst predetermined force. That is, the proximal portion (3652) mayfunction as a cutting board to ensure that even small fibers of tissue(3674) (e.g., second portion) are cut from the septum (3670).Alternatively, a preload force may not be applied to the tissue (3674)and electrode (3620) when delivering an ablation waveform to theelectrode (3620). During energy delivery, the dilator (3650) maynaturally withdraw into the lumen of the electrode (3620) after tissue(3674) is cut (e.g., ablated)

In some variations, a proximal portion (3652) of the dilator (3650) asshown in FIG. 36B may be disposed within a lumen of the electrode (3620)when a mating surface (e.g., proximal portion (3652) engages theelectrode. The proximal portion (3652) arranged within the lumen of theelectrode (3620) may securely and coaxially attach the electrode to thedilator. For example, the dilator may be secured to the first catheter(3610) to withstand dislodgment from a lateral load such as when theablation device is tracked over a curved guidewire. Furthermore, theelectrode (3620) securely engaged to the dilator (3650) may beconfigured to prevent the ablation device (3600) from catching (e.g.,snagging) against a vessel, tissue (e.g., transseptal crossing),introducer, sheath, and the like during advancement and withdrawalthrough a body cavity. In some variations, between about 0.5 mm andabout 2 mm of the proximal portion (3652) of the dilator (3650) may bedisposed within the lumen of the electrode (3620) when the matingsurface engages the electrode (3620). In some variations, the ablationdevice (3600) shown in FIG. 36B may be withdrawn from the patient.

The first and second catheter may be withdrawn from the patient (1816).This may include withdrawing the excised tissue held within the firstcatheter as the first and second catheters are withdrawn together. Insome variations, the procedure may be ultrasonically and/orfluoroscopically imaged during one or more steps.

Examples

FIGS. 20 and 21 are perspective views of variations of ablation devices(2000, 2100). In some variations, the ablation device (2000, 2100) maycomprise a first catheter (2010, 2110) and a second catheter (2030,2130). The first catheter (2010, 2110) may comprise a tubular electrode(2020, 2120). The electrode (2020, 2120) may define a lumen (2022, 2122)configured to hold a barb (2040, 2140) of the second catheter (2030,2130). The tubular electrode (2020, 2120) may comprise a cylindricalshape. In some variations, the ablation device (2000, 2100) may comprisea second catheter (2030, 2130) slidably disposed within the firstcatheter (2010, 2110). The second catheter (2030, 2130) may comprise abarb (2040, 2140) and a dilator (2050, 2150) configured to engage theelectrode (2020, 2120). In some variations, the barb (2040, 2140) maycomprise a plurality of projections that are angled generally towardsthe electrode (2020, 2120). The dilator (2050, 2150) may comprise atapered, conical shape. FIG. 22 is perspective view of an ablationdevice (2200) engaged by excised tissue (2260). In some variations, theablation device (2200) may comprise a first catheter (2210) and a secondcatheter (2230). The excised tissue (2260) fits within a lumen (2222) ofthe electrode (2220) for removal from a patient.

FIG. 23 is a fluoroscopic visualization (2300) of ablation devices(2310, 2320) in respective open and closed configurations. One or moreportions of the ablation devices (2310, 2320) may comprise a radiopaqueportion.

FIG. 24 is an image (2400) of an anastomosis (2420) formed in cadavertissue (2410) using the ablation systems and methods described herein.FIGS. 25A and 25B are images (2500) of an anastomosis (2520) formed inporcine tissue (2510) using the ablation systems and methods describedherein.

FIGS. 27A and 27B are perspective views of variations of an ablationdevice (2700) engaged to tissue (2760). In some variations, the ablationdevice (2700) may comprise a first catheter (2710) and a second catheter(2730). The first catheter (2710) may comprise a tubular electrode(2720). The electrode (2720) may define a lumen (2722) configured tohold a barb (2740) of the second catheter (2730). The tubular electrode(2720) may comprise a cylindrical shape. In some variations, theablation device (2700) may comprise a second catheter (2730) slidablydisposed within the first catheter (2710). The second catheter (2730)may comprise a barb (2740) similar to the variation depicted in FIGS.26A and 26B and a dilator (2750) configured to engage the electrode(2720). In some variations, the barb (2740) may comprise a plurality ofprojections comprising tissue engagement portions that are substantiallyparallel to a longitudinal axis of the second catheter (2730). Thedilator (2750) may comprise a tapered, conical shape.

Tissue (2760) may be configured to be engaged to the barb (2740) asdescribed in more detail herein. Although the second catheter (2730) isadvanced relative to the first catheter (2710) in FIGS. 27A and 27B toshow the barb (2740) and excised tissue (2760), the excised tissue(2260) fits within a lumen (2722) of the electrode (2720) to facilitatetissue removal from a patient. In some variations, the lumen (2722) mayhave a length of at least 1 mm. For example, the lumen (2722) may have alength between about 5 mm and about 4 cm. FIG. 27C is an image (2770) ofan anastomosis (2790) formed in tissue (2780) using the ablation systemsand methods described herein.

FIGS. 28A and 28B are perspective views of variations of an ablationdevice (2800) engaged to tissue (2860). In some variations, the ablationdevice (2800) may comprise a first catheter (not shown) and a secondcatheter (2830). In some variations, the ablation device (2800) maycomprise a second catheter (2830) slidably disposed within the firstcatheter. The second catheter (2830) may comprise a barb (2840) similarto the variation depicted in FIGS. 26A and 26B and a dilator (2850). Insome variations, the barb (2840) may comprise a plurality of projectionscomprising tissue engagement portions that are substantially parallel toa longitudinal axis of the second catheter (2830). Tissue (2860) may beconfigured to be engaged to the barb (2840) as described in more detailherein.

As used herein, the terms “about” and/or “approximately” when used inconjunction with numerical values and/or ranges generally refer to thosenumerical values and/or ranges near to a recited numerical value and/orrange. In some instances, the terms “about” and “approximately” may meanwithin ±10% of the recited value. For example, in some instances, “about100 [units]” may mean within ±10% of 100 (e.g., from 90 to 110). Theterms “about” and “approximately” may be used interchangeably.

The specific examples and descriptions herein are exemplary in natureand variations may be developed by those skilled in the art based on thematerial taught herein without departing from the scope of the presentinvention, which is limited only by the attached claims

Although the foregoing implementations has, for the purposes of clarityand understanding, been described in some detail by of illustration andexample, it will be apparent that certain changes and modifications maybe practiced, and are intended to fall within the scope of the appendedclaims. Additionally, it should be understood that the components andcharacteristics of the elements described herein may be used in anycombination, and the methods described herein may comprise all or aportion of the elements described herein. The description of certainelements or characteristics with respect to a specific figure are notintended to be limiting or nor should they be interpreted to suggestthat the element cannot be used in combination with any of the otherdescribed elements.

In addition, any combination of two or more such features, structure,systems, articles, materials, kits, steps and/or methods, disclosedherein, if such features, structure, systems, articles, materials, kits,steps and/or methods are not mutually inconsistent, is included withinthe inventive scope of the present disclosure. Moreover, some variationsdisclosed herein may be distinguishable from the prior art forspecifically lacking one or more features, elements, and functionalityfound in a reference or combination of references (i.e., claims directedto such variations may include negative limitations).

Any and all references to publications or other documents, including butnot limited to, patents, patent applications, articles, webpages, books,etc., presented anywhere in the present application, are hereinincorporated by reference in their entirety. Moreover, all definitions,as defined and used herein, should be understood to control overdictionary definitions, definitions in documents incorporated byreference, and/or ordinary meanings of the defined terms.

The invention claimed is:
 1. A method of forming an anastomosis in aheart, comprising: advancing a first and second catheter into arightatrium, wherein the first catheter comprises an electrode defining alumen and the second catheter comprises a dilator and a rigid barb,wherein the rigid barb comprises a projection coupled to a base portion,wherein the base portion couples the projection to the second catheter,and the base portion spaces the projection proximally from the dilator;wherein a largest outer diameter of the barb is less than a largestouter diameter of the dilator, and a largest outer diameter of the baseportion is less than a largest outer diameter of the barb; advancing thesecond catheter into a left atrium through an interatrial septum suchthat the first catheter is in the right atrium; tenting a first portionof the septum over the second catheter by withdrawing the secondcatheter towards the first catheter a first distance such that the firstportion and a portion of the dilator are withdrawn into the lumen of theelectrode; compressing a second portion of the septum between theelectrode and the dilator by withdrawing the second catheter towards thefirst catheter by a second distance; and cutting the compressed secondportion by delivering an ablation waveform to the electrode such thatthe first portion is held within the lumen.
 2. The method of claim 1,wherein tenting the first portion comprises withdrawing the barb intothe lumen.
 3. The method of claim 1, wherein the projection comprises afirst portion of the projection coupled substantially perpendicularly tothe base portion and a second portion of the projection coupledsubstantially perpendicular to the first portion of the projection,wherein tenting the first portion of the septum comprises piercing thefirst portion of the septum using the second portion of the projection.4. The method of claim 1, wherein tenting the first portion comprisesholding the first catheter in a substantially fixed position whilewithdrawing the second catheter towards the first catheter.
 5. Themethod of claim 1, wherein the tented first portion forms asubstantially conical or cylindrical shape.
 6. The method of claim 1,wherein tenting the first portion comprises piercing the first portionwith the barb.
 7. The method of claim 1, wherein tenting the firstportion comprises rotating the barb about a longitudinal axis of thebarb relative to the first catheter.
 8. The method of claim 7, wherein asize of the first portion corresponds to a rotation angle of the barb.9. The method of claim 1, wherein tenting the first portion comprisestranslating the barb longitudinally relative to the dilator.
 10. Themethod of claim 1, wherein tenting the first portion comprisestransitioning from a first configuration where the barb is arrangedinside a recess of the dilator to a second configuration where the barbis arranged outside the recess via longitudinal translation.
 11. Themethod of claim 1, wherein the second distance is greater than the firstdistance.
 12. The method of claim 1, wherein compressing the secondportion comprises a preload force of up to about 25 N.
 13. The method ofclaim 1, wherein compressing the second portion comprises engaging theelectrode and the second portion to a mating surface of the secondcatheter.
 14. The method of claim 13, wherein the second catheter iswithdrawn towards the first catheter by the second distance such thatbetween about 0.5 mm and about 2 mm of the dilator is disposed withinthe lumen.
 15. The method of claim 1, wherein compressing the secondportion comprises rotating one or more of the barb and the dilator abouta longitudinal axis of the second catheter relative to the firstcatheter.
 16. The method of claim 1, wherein cutting the compressedsecond portion comprises withdrawing the second catheter towards thefirst catheter.
 17. The method of claim 1, wherein cutting thecompressed second portion is performed after tenting the first portion.18. The method of claim 1, wherein a size of the first portion cut fromthe second portion is independent of a diameter of the electrode. 19.The method of claim 1, wherein a size of the first portion cut from thesecond portion corresponds to a distance the barb is withdrawn into thelumen.
 20. The method of claim 1, wherein cutting the compressed secondportion comprises forming an anastomosis in the septum comprising adiameter of between about 1 mm and about 1.5 cm.
 21. The method of claim1, wherein cutting the compressed second portion comprises engaging thefirst portion to the barb.
 22. The method of claim 1, wherein cuttingthe compressed second portion comprises electrically shorting theelectrode by contacting the dilator.
 23. The method of claim 1, whereinthe ablation waveform comprises a two-phase waveform.
 24. The method ofclaim 1, wherein the ablation waveform comprises a first waveformfollowed by a second waveform, the first waveform comprising a firstvoltage and the second waveform comprising a second voltage, and thefirst voltage higher than the second voltage.
 25. The method of claim 1,wherein the ablation waveform comprises a current between about 50 mAand about 4 A, a voltage of between about 0.1 kV and about 4.0 kV, and afrequency of up to about 500 kHz.
 26. The method of claim 1, whereinfurther comprising introducing a contrast agent into a lumen of theelectrode.
 27. The method of claim 1, further comprising introducing acontrast agent into the heart via a fluid port in the dilator.
 28. Themethod of claim 1, further comprising receiving ultrasound waves from adistal end of the ablation device.
 29. The method of claim 1, whereinthe projection is coupled proximal to the base portion.